This podcast delves into the critical and sensitive topic of suicide, addressing its prevalence and the complexities surrounding suicidal thoughts. Mental health professionals Michael Stratton and Morgan Bowen openly share their experiences and insights, emphasizing that while many individuals may have suicidal thoughts, not everyone acts on them. They discuss the importance of understanding the underlying factors that lead to these thoughts, including mental health disorders and life circumstances. The conversation also highlights the significance of open dialogue and seeking help, encouraging listeners to reach out to crisis hotlines like 988 if they are struggling. Ultimately, the episode aims to provide education and awareness about suicide and mental health, reinforcing the message that there is always hope and help available.

Website: 988 Lifeline

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Welcome to a Psycho delicious conversation on mental health issues and trends from two local mental health professionals in the greater Lansing area. I'm Michael Stratton, lmsw.

And I'm Morgan Bowen, dnp, pmhnp. And we're here to provide you with a deep dive into the human experience of consciousness and beyond. Our aim is to be educational and entertaining.

So just kick back and open your ears and your minds.

Hey, I'm Mike Stratton.

And I'm Morgan Bowen.

You know, it's interesting what we come up with on a week by week basis, you know, to talk about. It's a different, different thing at different times.

This one is a really serious topic and we're gonna address like a trigger warning right off the top.

Yes. Yeah, that's good point.

Because we are gonna talk about suicide and anyone who's feeling suicidal. Keep that in mind, you know, and consider calling 988 Suicide Crisis Lifeline.

And that should help you because we're going to talk about a number of things of what? Just the dynamics of it, the scope of it, which is pretty large. How to assess it, how to work with it. I mean, all those kinds of things.

Yeah, it's kind of the, you know, it's the.

I don't, I'm trying to nth degree, the most extreme, one of the most, most serious things that we deal with in mental health and what people deal with when they have a mental health crisis. Certainly not everybody, you know, not everybody with a mental health issue deals with this, but it can be a part of people's life.

Certainly depression, serious depression, especially depression that is chronic and tends to be lifelong or bipolar disorder as well. Another mood disorder, schizophrenia. People with psychotic disorders frequently for many reasons, but the severity of the symptoms are just so.

They're heavy to live with, they're hard to live with.

Yeah, exactly. And I think that that's one of the ways that I think about suicide. The idea of something that's hard to live with.

More obviously more people have the thought of suicide than actually attempt it.

And that's an important distinction.

Oh, really important.

And it's surprising to me when I first meet with people and I will at some point talk about depress and then suicide, you know, have you ever had suicidal thoughts? It's interesting to me what a high percentage of the people actually have had suicidal thoughts.

Like I would, I haven't done exact numbers, but I would guess 80 to 90% of the people I see have had that thought at some point or another. I've had that thought in the past.

Me too.

Yeah. Yeah. My dad had it. I grew up with a dad who was very, very depressed. And there was always that worry about is he going to kill himself or not.

My mom would tell us, he's going to kill himself, which was like, not a great thing to hear as a kid.

Yeah, no, that's. That's. Yeah, that's tough.

Yeah. And then he would tell us stories about how his mom talked about killing herself if he went out on a date.

This is a multi generation. This is a multi generational topic.

Why wouldn't I think about generational stuff like that?

So, but the idea, it's interesting because, and I've mentioned this before, that I've been in therapy a number of times, but kind of early in the process, someone explained to me, just because you have those suicidal thoughts, that's kind of a red flag that things are not going well in your life and that you're thinking about, well, I could do this. I could escape. If I did this, I could get out of this. And it's almost like a relief.

Like it's something that comes up on your computer screen, a program that you don't intend to click on, but it's there. And just the fact that it's there is significant.

A lot of people talk about intrusive thoughts. I'm having an intrusive thought.

It seems to come at times of stress, but sometimes it comes out of nowhere where there's, I'm just going to drive off the road.

A lot of people say that to me when we're working together or they're just in a scenario or a situation where it strikes them that they could do something that would end their life. It's not that they want to, but that is a scary thought in some ways. You know, we. We try to normalize that.

I don't want to say that's a normal thing, but it's not.

Understand it and explore it.

Yeah, exactly. Right. It doesn't mean that. It doesn't always mean that the person is, you know, on the road to suicide, but it's scary. So people. People don't.

Sometimes people just don't understand that. So working, you know, talking about it is important.

Yeah. One theme I talk about a lot in these podcasts has been a continuum.

So the thought of it I don't think is at all uncommon, but the idea of having a recurrent thought about it and then the idea of how would I do it?

And gathering the means to do it and making a plan If I would do it in this way, at this time, at this place, all of those increase the seriousness of it, that becomes more real. So all of those are factors to kind of look at.

Yeah, yeah.

When I'm doing, and I'm sure you as well, but when we're talking with somebody, I'm really trying to get a good idea of the severity or the risk really of suicide. Those are the things that we'll ask. When it does come into your mind, how long do you think about it? Does it happen daily?

Does it happen in response to situations or does it seem to come out of nowhere? Is it something that you spend time thinking about? It happens multiple times throughout the day. Are you approaching a plan?

Have you researched a plan? Have you thought about a plan?

Then taking steps to enact a plan, writing a note, sometimes making decisions about what will happen to your things or what would happen to your family afterwards. That's a dangerous situation or definitely a much more severe situation than a passing thought or a more reactive type of thinking.

Something bad happens and you just want to kind of get away from it or escape it or not deal with something.

Yeah. I've had clients who are kind of surprised when, you know, when they.

When they do talk about it, sometimes they'll say, I don't want to talk about it with you because you'll lock me up. And they're surprised when it gets into that point of like, really, let's explore this a little bit.

And just what you said, part of it is also the fantasy of what will happen after you're gone, both what happens to you and also what happens to the people around you. What do you imagine is that? Do they have a particular fantasy? Would so and so be really hurt? Will so and so be really mad?

Will so and so be, you know, whatever it is. And you can get to some of the underlying feelings. You know, I want to do this.

So so and so will feel miserable, for instance, versus oh, my gosh, I didn't even think about what it would be like. Sometimes people will have that sense of being so insignificant that no one will care, or the world would be better off without me.

So you can really get to some underlying dynamics if you let yourself explore that with somebody.

And when we start seeing somebody, or I'm sure you as well, but we have to talk about confidentiality. And then there are some caveats to confidentiality.

So one of those, if I am concerned that the person is going to hurt themselves or attempt to do something, then I would break confidentiality. In order to get some help or get them to safety. But I always have a cat. I always say I talk to people a lot about suicide.

It's a pretty standard question with every assessment. But thinking about it doesn't mean that you're going to get locked up. It really is, I guess.

Well, it is up to us as clinicians to understand what the risk factors are and when it is a dangerous situation.

Yeah, I was thinking that probably the most famous line to come out of Shakespeare, maybe one of the top five most famous lines of all of literature, but Shakespeare in particular comes out of Hamlet, to be or not to be. And that is the question, am I going to stay here and deal with my life? Do I check out now?

Do you remember what was going on in Hamlet?

Hamlet was. It was his soliloquy, and he was trying to figure out what to do.

Hamlet was very famous for his ambivalence, waffling, and uncertainty about what to do next and whether he's going to rise up against his uncle, who was a ruthless bastard, or whether he's going to just check out and leave it. Leave it all.

I haven't read Hamlet in a long time.

Me, too.

But I do know that line.

Do you believe that most people are pretty honest when they fill out those initial intake forms? I can tell you that I was a little bit hesitant when I went to go see my therapist and asked about the suicide.

And I was like, well, how serious was I? Not very, but it came to my.

Brain and just the idea, like, I'm going to. I'm gonna document this on a form.

Yeah, that was part of it.

That was part of it.

And it was almost like I was hesitant to do it just because I didn't want the therapist thinking I was taking it seriously, because I did not feel like I was. It was just. It came to my brain. It went away.

Well, I think it.

I think I was like, no, that's.

Not an answer for me, what you're saying today.

And I think speaks to the idea of stigma of what's going to happen inside therapy and people verbalizing, like, is this going to be used against me at some point? Is this going to be used to lock me up? And so people have those kind of fantasies and, like, probably what you do. Morgan, too.

I make the distinction when I say, this is one of the ways that I would break confidentiality. If I had a really serious concern about you hurting yourself, I would contact, you know, someone and try to get you more help. You know, that.

That's what it is. It's not about punishment. But at the same time, a lot of people say that they've had suicidal thoughts or they feel like committing suicide.

And that's not something I would break confidentiality for. It would just be the level of lethality, you know, the level of, like, okay, it really feels like this could happen with this person. So.

And I. And it's very common that people won't, you know, indicate it on the forum. And I think there is a right to privacy.

I mean, you know, just because you're in therapy, you don't have to unveil all of your thinking at one time, certainly before you've met and developed a relationship with the therapist. And so a lot of times people won't say it.

And then when we do meet and talk and we, you know, they feel more comfortable or, you know, through our therapeutic relationship, will, you know, will reveal or be more honest about.

And I'll say that was my experience.

Yeah, Yeah.

I mean, because I didn't feel like I was completely truthful in that area when I filled out the form. But later on it became a little bit of a discussion.

So, you know that I always see it when I'm in, like, my primary care office. It's like, you know, do you have gastrointestinal whatever? Can't, you know, all these things? And it's like, are you thinking of killing yourself?

I'm like, who? Who says yes? But I had people that have come to me having had said yes, and then the primary care refers them out.

Some people are compulsively honest and feel the importance of that.

I think primary care providers are doing a lot better job.

That's true.

Doing that screening for depression and for suicide. They never used to ask those questions, and now it's a regular thing where they do ask.

True, true. And that is a big thing with folding kind of regular mental health screening into primary care. And it's great. It's really, really a good thing.

Well, I looked into some statistics which might stir up some other thoughts and things that we can talk about at risk populations, youth and adolescents. Did you know that suicide is the second leading cause of death for teens from ages 10 to 19?

I did know that the older you.

Get, the more likely you are to commit it.

So I'll say was when I was younger, when I was a teenager, I did experience, and it had a lot to do with being gay, which is another at risk population. LGBTQ folks have a higher percentage of suicidal ideation.

And so my parent came out to my parents and everything kind of collapsed and seemed like the world was over for me. So that was really the only time that I was very persistently in a kind of a risk zone.

Yeah, Yeah. I would say for me, it was when I was 16 was the most lethal.

And then in my adulthood, there were a couple of other times that that kind of would pop up. And just the thought, just a quick blurb, but the same kind of thing of just life was really, really hard. Things in the family were really bad.

And that just seemed like, well, there's a way out. I could do that. But I didn't.

You know, what I kept thinking at that time was this particular person, Terry Enfield, was a friend of mine. So, Terry, if you're out there. But I kept thinking about what it would be like for friends of mine to know.

In some ways there was like, oh, my funeral, and everybody's going to be so sad. But then when you're seriously thinking about it and just how. I mean, it's just. It's devastating. Suicide really is.

It's just a special burn for the family, for the people, for the loved ones who are left behind. It's just devastating.

So I don't think I had a real concept of that, but I just remember thinking Terry Enfield would be really upset if I killed myself. Terry Enfield, seems to me he saved you.

He saved you.

It's a girl. She.

Oh, she. See?

Well, the numbers are really startling. You know, 5% of males and 9% of females in high school have reported having a suicide attempt in the last year.

Yeah, it's pretty startling. It's huge. Yeah, it really is.

It's huge.

And this usually comes from. There's a Youth Risk Behavior Survey. Yeah, the Y. And it is. I used that a lot in my studies when I was in school, and it's very startling.

Yeah. Bullying, abuse, neglect, sexual abuse, parental mental illness or suicide attempts, isolation.

And during COVID everybody experienced that, especially teenagers. And they thrive on social contact. And all of a sudden, they were all isolated from each other for a couple of years.

Traumatic injury, all those kinds of things. That's really difficult. The other thing that LBGQ individuals. This was kind of interesting to me.

The passage of laws to discriminate against this population coincides with an increased substance use and also suicide attempts. So when people talk about, let's outlaw this and let's deny marriage to gay people, that coincides with increased.

It does. I see a lot of gay.

I see a lot of people in the community, trans folks, gay Folks, and particularly trans, you know, the anti trans movement, I guess I would call it legislation. Not necessarily in Michigan. Michigan actually passed a civil Rights act. The Elliot Larson. Yeah, Civil Rights Act.

So we are doing better, but that's only recently in the current Whitmer administration. But Texas, Florida, you know, places that have passed a variety of things. No, you know, no hormone treatment for, you know, people.

Pediatrics, you know, stuff like that. The trans community is very connected, especially like, you know, digitally through, like online. And there's.

There's like almost this like kind of underground railroad type of thing trying to get trans folks out of areas that are in these really conservative red states and get them into more, you know, more. More liberal or more tolerant. Yeah, tolerant places.

Environment.

Yeah.

Right, right, right, right.

Accepting.

Accepting. Yeah, yeah, that's.

That's. That's true. That's good. Another couple of populations. Veterans.

Veterans and other military personnel are at high risk, and so are the elderly people over 85. That's a. That's a high risk. I am not over 85.

Well, I would never ask that, Mike.

No, no, I'm not. No, I'm not.

Anyway, elderly suicide, though, is a thing. I mean, it's a big thing. Yeah. Loneliness, isolation, People's. You know, I'm the last one left. All my friends are gone.

My spouse is gone, my children may be gone. You know, I can't travel. I can't. You know, it's very isolating. It can be.

I think maybe there was hope maybe. I don't know, maybe after the election. I don't know. Okay, I'm gonna get political for a minute.

So the first time I encountered suicide really closely was when I worked in day treatment over at St. Lawrence Hospital.

So we had kind of a partial hospitalization set up there, and I was working there with a Population of basically chronically mentally ill people, often schizophrenic, but other diagnoses as well. And I left that after working there for a couple years and went to graduate school.

And that coincided at the time when Blanchard lost the election to Engler.

And one of the first things Engler did was to decrease social spending on these programs that these people had all kinds of services available to them. You know, they had housing, they had case managers, they had people looking after them, they had places to go during the day.

And we had five suicides within the next two years amongst that population. So, I mean, policies, they matter. They really do matter, and the services really do matter.

And you didn't see people standing on street corners begging for money in those years like you do now. So, anyway, just to sound off on this stuff, Frank Okberg was the medical director, and he's the guy who came up.

I think he came up with the Stockholm syndrome. He wrote about that.

Yeah, I know what that is, but I couldn't connect it to anybody.

But he came down and he talked to the staff after this. So the suicides had occurred after I had left.

But it just wrecked me to know some of these people who had died during that time, and at least two of them for sure, were suicides. And when I talked to them about it, they said something that he had said that Frank Okberg had said to them. He said, you don't like it that people.

You know, this goes against everything we try to do in mental health, is try to help people, try to help people thrive, help people survive things, he said. But ultimately, ultimately people have a choice. And you don't have to like it, but you have to respect it, is what he said.

And that was just such a different way to think about it than I'd ever thought of before. Now, having said that, once again, trigger warning. If you think, oh, this validates my ideas about killing myself, call 988. Call 988.

Because even though it helps the survivors to know, like, okay, well, we can respect their choice, you don't have to make that choice. So there is a way out. No specific crisis will define your entire life, and people get through hard stuff.

There are some risk factors, too, that I wanted to talk about. But access to a firearm is probably the most. It is the biggest risk factor because of the lethality, for sure, and then also the quickness. It's very.

If somebody impulsively decides to do something, a firearm can be a very permanent thing over any really, you know, any method can be, but you know, overdoses, you know, there's, there's a lot of people survive suicide attempts, but it's hard to survive a firearm attempt. Male, and this is, you know, in the adult population.

Male tends to be, you know, just in and of itself a risk factor, at least more substance use, substance abuse is as well.

Women are more likely to attempt it, men are more likely to succeed at it, which is interesting. And men are more likely to use a gun. So that may be a big factor with that.

So I, you know, and I would wonder what your experience is.

But a lot of I worked inpatient where there's a lot of inpatient treatment is geared towards, you know, suicide prevention or you know, post suicide kind of providing somebody with a safe space. So the substance use piece, people are intoxicated when they attempt. A lot of times people are really scared to do it.

And so, you know, alcohol or substance, some type of substance is frequently, at least in my experience, involved in the attempt.

Yeah, yeah, I guess probably in part two we're going to talk about treatment of depression and different, different ideas with suicide. But before we get there, just once again to emphasize 988 if you don't want to go on to the second part of this, which would be helpful if you did.

But 988 is the hotline for that. There are other community based programs that are available to people, just crisis hotlines.

There's a national suicide prevention which is 1-800-273-TALK. 1, 800-273-TALK and of course 988.

And there's also, if you want to get involved, there's training program, gatekeeper training programs and community awareness campaigns. There's school based programs as well.

There's counselors and therapists in every school these days in Michigan and policy advocacy, peer support groups, the American foundation for Suicide Prevention and let's see, Michigan Suicide Prevention Commission and also nami. Nami, the National Society.

Yeah.

There's a huge amount of resources for influencing policy as well as creating and executing programs for suicide prevention, especially with youth, which is great and in the schools.

And the last thing I want to say is that for myself, even though I have these stray thoughts occasionally, even within the last couple years I've had a stray thought. It's always a red flag for me. Always talk about it with somebody else. Always, always, always mention it to someone else.

I that some things grow well in the dark and those kinds of thoughts grow well in the dark. Those kind of secrets grow in the dark. So make sure you talk to a loved one or a caring professional, or.

Call 988 or call 98.

A psycho. Delicious conversation is meant for educational and entertainment purposes only. It is no substitute for therapy and should not be treated as such.

If you feel a need for real therapy, you should consult your local provider, Google therapy, or therapists in your area. Check with community Mental Health or a suicide hotline if you are feeling suicidal.

Mike and Morgan welcome your questions, feedback or dilemmas.

Feel free to send us an email at a psychodelicious conversationmail.com that is a psychodelicious P S Y C A H O D E L I C I o u s conversationmail.com the views expressed.

On this podcast are solely the opinions of Mike Stratton and Morgan Bowen and do not reflect the views or opinions of any site broadcasting this podcast. Replication of this podcast without written permission is strictly prohibited.