(Part 1 of 2) This episode features Dr. Julie Cerel, Professor in the College of Social Work at the University of Kentucky and president of the American Association of Suicidology. Dr. Jones talks with Dr. Cerel about suicide in the media (13 Reasons Why), law enforcement, #not6, her research regarding those affected by suicide and why it happens. Part 2 will continue the conversation about suicide in the media and also focus on preventing suicide with those at risk and help for suicide loss survivors.
If you, or someone you know, are at risk for suicide, there are people who can help. We suggest one of the following:
- National Suicide Prevention Lifeline (24/7) 1-800-273-8255
- Crisis Text Line – Text 741741 (24/7) a live, trained volunteer can talk you through your crisis
- Call 911 for immediate help
Info on Dr. Julie Cerel:
American Association of Suicidology: http://www.suicidology.org/
Seeking Hope: Stories of the Suicide Bereaved (Book) by Dr. Julie Cerel and Dr. Michelle Linn-Gust
Additional music credits “Shadow” by Jason Paul Johnston http://www.jasonpauljohnston.com
Transcripts are created using a combination of speech recognition software and human transcription and may contain errors. Please check the full audio podcast in context before quoting in print.
Dr. Jones: [00:00:01] I’m joined today by Dr. Julie Cerel She’s a professor here at the University of Kentucky College of Social Work. Thank you so much for joining me this morning.
Dr. Cerel: [00:00:08] Thanks so much for having me on.
Dr. Jones: [00:00:10] It’s great to have you. You know you and I have a professional relationship that goes back for a while we’re doing a little bit of research together which we’ll talk about but I really want to get into talking about your area of research and really this passion that you’ve had in your professional life. So I wonder if you could tell us a little bit about what you do here at our college and how long you’ve been here those kinds of questions.
Dr. Cerel: [00:00:35] Sure. So I have been with the University of Kentucky College of Social Work since 2005 and I am also serving as the president of the American Association of Suicidology for a two year term that started in April of this year. I’ve been interested in suicide throughout my career. My master’s thesis I was working on a study of kids who are bereaved for a wide variety of reasons by the death of a parent. And I was really interested in psychopathology and kind of how that affects families and family systems. And so at that point my advisor suggested that I look at the 26 kids from 15 families in our sample that were bereaved by the suicide of a parent. And I finished my master’s thesis and got it very easily published into a pretty reputable journal and thought oh this this academic thing is easy. It was the easiest publication I think I’ve ever gotten into the best journal. But when I started to look around the reason that it got published so quickly was that this study of 26 kids from 15 families was the largest study to date of suicide bereaved children. And so it really made me realize that this is a hugely untapped area right now there’s over 44,000 people a year that die in the US by suicide. And the people whose lives are forever affected by those suicides are who I’m most interested in helping, who I want to figure out what they need and how to help them.
Dr. Jones: [00:02:12] Yeah you have developed kind of the specialty area in this research of people who are affected and I wonder if you could talk a little bit about you you even We’re talking before we started that you even have a hash tag that you’ve developed about “not six” so you talk a little bit about that.
Dr. Cerel: [00:02:31] Yeah definitely. So when I started talking to people about my work they’d say well that’s just bereavement even if it’s a suicide even if it’s this horrible and unanticipated death it’s just grief. Everybody has grief and this isn’t really an area that that should be of interest to researchers. Then there was this number six that was floating around for 40 years. Ed Shneidman who is the father of modern suicidology was asked how many people are affected when someone dies by suicide. And he thought and he said, “mmm…six” and various people I never met Ed but over the years various people tried to figure out where that number came from and before he died a few years ago there were two competing theories because he’d said them to different people at different times. One was that six was the number of people who are compensated after some sort of airline disaster. So six immediate family members were compensated and then the other was that it was some court case where bodies were buried in a cemetery and six family members were compensated. The point we’ve been trying to make is that it’s not six. I spent a lot of time over the last few years gathering data and trying to figure out what is the number. But we know for a fact it’s not six. It’s exponentially more than six people that are impacted by a suicide. And what we’ve done so right now it looks like based on the data we have the numbers about 135.
Dr. Jones: [00:04:04] How do you go about gathering that data – How do you make that model.
Dr. Cerel: [00:04:08] So we came up with a conceptual model of who is it that could be affected by suicide. And we we refer to this is the continuum of exposure and within the continuum of exposure of those people that you know someone that dies by suicide. Those folks we refer to as exposed. So that could be a family member. It could be someone who loses someone in their community or faith. It could be a therapist that loses a client could be a first responder. So those folks are exposed what we don’t know is of all those people who were exposed. And we have some data both from a random digit dial survey in Kentucky and now that’s in submission from an in-person study. A door to door in-person study we had some questions added on to the General Social Survey that almost 50 percent or a little more than 50 percent of Americans say that over their lifetime they’ve known at least one person who’s died by suicide. But what we don’t know is of those people who are exposed who’s going to go on to be what we refer to as affected. They might have some sleepless nights. They might think about it a lot. They might have some symptoms of what we refer to as depression or PTSD. But probably not enough that they need to seek treatment for short term or long term. Of those people, some of them will go on to need some treatment or need some help. And we refer to that as suicide brief short term and then for some people this will completely alter their life trajectory in the long term suicide bereaved long term they might need therapy or support groups it might negatively affect their life trajectory or it might also actually change who they are fundamentally shake them up and they might experience was referred to as post-traumatic growth. So we’re looking at all aspects of that to try and figure out when someone has this experience what do they need. Not just how many people are there but who’s going to end up and which of these trajectory is right.
Dr. Jones: [00:06:13] I want to go back I probably should have asked you this earlier but I want to set the groundwork for why people die by suicide because we have a lot of listeners who you know at all levels here we have students who listen we have other researchers who listen. Can you give us kind of a basic idea in general of why people died by suicide.
Dr. Cerel: [00:06:39] I think that is a complicated question. People want to say they want to point to one thing. They want to say oh is it “social media” is it “podcasts.” Is that why people are dying by suicide. It is not social media or podcasts (ha ha). It’s not the one reason. But seriously you know suicide happens just because of one thing. The best theory of suicide right now that people are using is Joiner’s inter-personal theory of suicide. And essentially what that theory posits is that three things kind of need to happen for someone to be suicidal and end up taking their life. The first is a fearlessness about death that either they have rehearsed the act of their suicide over and over but that they have familiarity with the methods. So certain professions then become at higher risk people that routinely use firearms and aren’t afraid of using them to injure someone. Emergency Department personnel who see blood and life and death all the time things like that. So it’s that fearlessness about death. There’s also the feeling that you don’t belong anymore and that there’s nobody who understands you and the world is a place that you don’t belong. So in addition to that thwarted belongingness the third leg is really perceived burdensomeness this not just that you don’t belong but you’re actually a burden on those around you. And so I saw a mom who had attempted suicide on her twins, I want to say it was their, 11th or 12th birthday and she really felt like by ending her life on their birthday they would be so much better off without her and they would be freed of the burden that was her. In reality, I’ve never met a family member who said, “Oh if only they had died” or “I’m so glad they died” because as many problems as people have their loved ones never want to be relieved of what the loved one feels is a burden.
Dr. Jones: [00:08:49] That’s really helpful because I do think that people often want simple answers for why people behave in the way that they do. And in this area does not provide a lot of simple answers. And it really depends on the type of person too. You know you and I are doing this study with law enforcement officers which we’ll talk about in a moment. But you know when you talk about exposure you’ve helped me think of that in a really different way. I did a police ride along this past week and I shared this story with you where I responded we responded to a suicide. It was late on Sunday night and you know we drove really fast to get there. And this was a veteran who had PTSD, alcohol problems and he and his wife were arguing and he killed himself with a pistol in the kitchen. There were little kids involved and it was it was horrifying for me and I I didn’t go into the house I just sort of stood out by the cruiser and watched the coroner come and the police and the firefighters and everything but it was really horrifying. I couldn’t sleep when I got home. So that that really made me think about their exposure the first responders exposure.
Dr. Cerel: [00:10:15] That happens over and over and over, yeah.
Dr. Jones: [00:10:17] And how they have to kind of compartmentalize what they see.
Dr. Cerel: [00:10:23] Right.
Dr. Jones: [00:10:23] Right. So I wonder if you could talk a little bit maybe about our study that we’re doing and what we’re finding and what we hope to do with that.
Dr. Cerel: [00:10:32] Yeah definitely due to your interest in law enforcement and my interest in these profound effects that we feel like suicide exposure can have on people. We’ve started the study because what we found in our previous research like I’d said is when we do surveys of the public about half of people report previous exposure to suicide death about 60 to 70 percent of people report suicide exposure or exposure to suicide attempts. We’ve done similar studies now in college students and members of the National Guard and really we know that people have these exposures. Law enforcement then is an area where we didn’t want to ask the question “Have you ever – Do you know of anyone that’s ever died by suicide?” because we had a sense that virtually all of them would have this exposure. We did a survey where we asked people that were law enforcement to take it. We had about 800 people across the nation who responded. And I believe it was like 98 percent of them reported they had at least one exposure to suicide. These are law enforcement careers ranging from less than a year to over 30 years. And on average they had about 30 exposures to suicide. And so you take your experience that you had not even seeing the scene and you amplify that and you think about kind of these images and experiences that law enforcement officers have had in suicides and we know and other kinds of trauma and violence and it becomes a risk factor for them if things aren’t going well if they have lots of obstacles if they are having interpersonal kinds of issues and then kind of they have this image available to them it’s kind of that reduced fearlessness.
Dr. Jones: [00:12:19] Right. It becomes almost kind of numbing. You know the officer that I wrote with that responded to the suicide. He was 31. He had he had been on the force about seven years and I was telling him about our study and you know I told you when we collected this data I thought that the average you know they have seen an average of 30 suicides. I couldn’t believe that. But then when I talked with him he said, “you know that’s probably about right.” In his seven years on the force he had responded and the other thing as we were driving away from that one I asked him about you know about that. I kind of didn’t want to do a therapy session in the cruiser but you know we sort of talked about and he said you know that guy we’d worked with him before we’d try to get him help. You know I it is what it is with him he was sort of a matter of fact when he said the ones that get to him are the kids.
Dr. Cerel: [00:13:15] Right.
Dr. Jones: [00:13:16] The teenagers who are impulsive and do that so he did have that kind of reaction to to younger.
Dr. Cerel: [00:13:25] And that’s one of the things that we asked in our survey right we said is there one that really sticks with you and why does it stick with you. And as we’re starting to look at that it’s the ones that are young or when there are family members there or when it reminds the officer somehow somebody in their own life.
Dr. Jones: [00:13:44] Right.
Dr. Cerel: [00:13:44] And so what we don’t know is kind of what things will really trigger them so that one specific exposure out of 30 becomes an issue for them is kind of the straw that breaks the camel’s back. And they know hey you know now I really need to go get some help. I’ve seen all these things I should be strong I should be professional but it’s too much.
Dr. Jones: [00:14:05] Right. That’s why I think this research is so important. You know I work with these folks clinically in my practice and they are very resistant to going to see “the therapist.” You know they see that as a sign of weakness and I think if we can sort of normalize this as you know one thing I always say to them is you’re not robots you’re not out there just a robot. You know you’re not robocop.
Dr. Cerel: [00:14:30] And actually they’re more effective at their jobs if they’re not – if they have compassion and they’re seen as humans.
Dr. Jones: [00:14:35] Absolutely and yes. And so I hope that our our work can really help them. And I’m excited about it. It’s pretty exciting. Yeah. Tell me about your. You are the newly minted president of AAS. So what your what’s your agenda for that group.
Dr. Cerel: [00:14:54] Well, AAS is the nation’s oldest membership organization interested in all aspects of Suicidology. So we have seven divisions now about 2000 members and we cover the range of clinicians researchers people doing prevention work people who work for crisis hotlines suicide last survivor suicide attempt survivors as well as students. And so that’s that’s the whole field is different than most scientific professional organizations because most scientific professional organizations that scientists talking to scientists. And so when you go to an AAS meeting or you’re with the membership you have to remember that the people you’re talking to are really the people who have been most affected by this work. They’re the last survivors and the attempt survivors and the Crisis Center folks who are right there on the frontlines taking these calls day after day. And so for me that really changes how I think about it because I always have to think about how my science message is going to the people that are most affected by my work. So I is these seven different divisions this wide range of people and we’re really trying to figure out who we are at 50 years old. We’re working on a couple of different position papers so we have one on how physician assisted dying is different from suicide to really clarify the issues in physician assisted dying and palliative care in the states where it’s legal and suicide and then we’re working on a position statement on firearms and suicide and how we really hope that we can work with the gun industry instead of against them with the message that no one wants someone to use their own gun to end their lives.
Dr. Jones: [00:16:44] That seems really important politically that you align with them and kind of not against them because they’re very powerful. The gun industry.
Dr. Cerel: [00:16:53] I think for years the suicide prevention folks would say what are really facts that more than half of suicides occur with firearms. We don’t want people dying with firearms and the gun industry would say but people have a right to have guns and it became an impasse. And right now I think we’ve started to realize that if we want to change this issue we actually have to work together. And it’s not a matter of not letting people have firearms. It’s a matter of saving lives.
Dr. Jones: [00:17:31] I want to go over a little bit into media in and including in that social media and ask you about that because media especially for younger people is very powerful. It’s a very powerful medium. My boys are all in the snap chat and you know different things on on social media. I want to ask you about the show 13 reasons why I’m on your suicidology listserv. I know there’s been a lot of discussion about that. And and just in general how do you see media and social media play into suicide prevention.
Dr. Cerel: [00:18:09] Definitely so I avoided the media at all costs for my first many years in academia. I’ve gotten lots of messages about keeping my science pure and and communicating it in ways that make sense to other scientists. And then I started to realize that by doing that very few people actually get the message and are helped by my work. We see images of suicide in the media all the time. I teach a class here on suicide prevention intervention and post-event that’s an elective. And one of the things that I’ve had students do is spend two weeks a semester logging all of their media consumption whether it’s TV or movies or podcasts or. And then write down every time what they’re consuming has suicide in it and what we found is you can’t go a day usually you can’t go a couple of hours without having something that has suicide in it. So we’re exposed to suicide all the time and we need to figure out better ways of working with the media working with entertainment industry so that the exposures aren’t harmful for people. So in my role as American Association of Suicidology president I have begun fielding a lot of media requests. I think part of that was that 13 Reasons Why hit right before American Association of Suicidology’s annual conference in April. And so there are lots of opportunities for us to have discussions and talk about what we felt like could be very harmful in the show. There’s some evidence that when we see graphic images of suicides or people we admire who died by suicide that it really is one of the factors that people who might already be vulnerable and thinking of suicide take into account as they plan and attempt or actually die by suicide. And there’s some research that there’s actually been this increase in emergency department visits potentially but most definitely in media searches for how to kill yourself suicide things like that following the release of 13 reasons why.
Dr. Jones: [00:20:23] And for those who aren’t familiar with the show it’s a show about a young woman who dies by suicide and then they follow her after that, right she leaves notes.
Dr. Cerel: [00:20:34] She leaves tapes behind. And in the tapes she is this amazingly quirky put together teenager who describes there’s a tape 13 of them for each person that wronged her. Each person that contributed to her suicide attempt. The reality is that people that die by suicide actually less than 20 percent of people leave notes so that skews it already. But most of the time people are not able to coherently put together a quirky picture of all of the things that happened wrong with them. And so it paints this picture of suicide that’s just unrealistic.
Dr. Jones: [00:21:15] Right. Has anyone done any research on that show yet or are they doing research.
Dr. Cerel: [00:21:22] They haven’t done specifically on that show. I was asked to comment on a really ingenious study that some scholars did looking at Google searches and what they found is compared to another two week period the two weeks right after the show was released. They saw a spike in those searches for how to kill yourself suicide things like that.
Dr. Jones: [00:21:43] You know the the rate of suicide among teenagers. How does that compare to adults.
Dr. Cerel: [00:21:52] It’s always a tragedy when kids die by suicide and the rate has been going up over the last 20 years or so. But in reality the groups in the U.S. with the highest rates of suicide are men over 85 that have historically had the highest rates as well as most recently men in the middle years have started to overtake all other age groups.
Dr. Jones: [00:22:17] Why is that?
Dr. Cerel: [00:22:19] I think a lot of that goes back to Joiner’s theory that we talked about before. These are baby boomers right now who are kind of at midlife trying to figure out what it all means and what kind of success is enough. Are they a burden? Things like that.
Dr. Jones: [00:22:37] Yeah. Well Julie this has been a great conversation so far. I wonder if we could come back for another podcast and really talk more about how to help those folks who are at risk of suicide and also maybe how to help loss survivors.
Dr. Cerel: [00:22:53] Thanks, I’d really like that.
Dr. Jones: [00:22:54] All right everybody please join us for part two of our conversation with Dr. Julie Cerel.