Newman Lecture "How to Understand Suicide and its Aftermath: From a Scientific & Faith Perspective"

0:11Good evening, everyone. It is my distinct pleasure this evening to, introduce to you Doctor. Melinda Moore. I have a hard time not smiling when I say her name. I, there's so many reasons tonight to be to have gratitude for being here for me. This is such an important topic in, in our world today, in our society. It is directly relevant to our work as mental health professionals. It is directly relevant to, our personal lives, our families, our communities, our politics, our veterans, we can go on. Doctor. Moore, is a rising star, a true suicidologist, someone who has really, is making it her life's work to work in this area. Not the easiest area, of course, either. In an interview on 09/11/2018, in the Lexington Herald, Doctor.

1:28Moore wrote an op ed, I don't have time to read the whole thing to you, I wish that I could, and I'll just, I'll just read a little bit from that. She said, many may assume that preventing suicide is the job solely of the mental health community. In fact, research show that many individuals who may be experiencing thoughts of suicide frequently turn to faith, community leaders to help, before they will seek the help of mental health professionals. And so, I think tonight we're here in our capacity not only as mental health professionals but as members of a faith community that understands the way that these things often intersect, that these things in our view are very much part of how we see integration, that these things are always connected especially when it comes to issues around existential meaning.

2:20Doctor. Moore goes on to say that clergy are in a powerful position to demonstrate leadership on the stigmatized topic of suicide, and I really like that she just came out and said that, that it's stigmatized, let's just say it, you know, and get it out there, and it should not be encouraging, help seeking and leading their flock to life saving resources. Additionally, part of preventing further suicide is talking about the effect this death has on us. It is called suicide postvention. And the other thing I really like about Doctor. Moore's work is she doesn't only talk about suicide, she talks about what happens after, post traumatic growth, postvention. There's a hopefulness about her work that I find very uplifting.

3:09There's evidence that having an act of faith and being involved in a faith community helps protect people from suicidal thoughts, suicide attempts, and death by suicide, as well as help those who has, lost a loved one to suicide. I'm going to leave the rest to Doctor. Moore, but let me give you a little bit of background. She holds a PhD in clinical psychology from the Catholic University of America. She trained under Dave Jobes in what's something called CAMS. It's a very well known system of, assessing for suicide. The long name for it is the collaborative assessment and management of Suicidality. If anyone is interested in the back of Dave Jobes' book that you can buy on Amazon, what's the name of the book again, do you remember?

3:50Managing suicidal risk. Managing suicidal risk, CAMS is in the back of that book, I, I spoke to Dave a few years ago, and he said that anyone who buys the book can use CAMS in the back of the book, because I thought I needed his special permission, so, if you're interested in having a look at that, I highly recommend it. She also is a chair of the Kentucky Suicide Prevention Group, it's a statewide suicide prevention nonprofit, she's conducted military suicide bereavement research at the University of Kentucky, and suicide treatment research at the Roblierex Veterans Affairs Medical Center in Louisville. Her interest in post traumatic growth has emerged from her own experience with suicide and the changes that experience created within her, allowing for her current career path and personal interests and relationships.

4:40It is not my place to speak to Doctor. Moore's, personal, circumstances, but what I will say is that I met her as a PhD student. I remember, her just being a very dedicated and devoted student. She, I think you were working on the hill, dedicated and devoted student. She, I think you were working on the hill at the time, because you were much better dressed than the other students, and, you know, I think we had an evening class, it was brutal, I think it was seven to ten at night, and we ran through Nancy Maguillams from seven to 10PM, on Wednesday evenings, and, Doctor. Moore was in the class, so you can see what happens when you're a good student, You could become Doctor. Moore, no pressure.

5:24So without further ado, I also just want to, say, I also want to make a plug for this book, that Doctor. Moore edited with Daniel Roberts, The Suicide Funeral or Memorial Service. It is a wonderful book, I've looked at it on Amazon, and, it is co written with faith leaders, including, Ron Rohlheiser, who many of you will recognize, but also some, Jewish scholars and, I, I highly recommend that you have a look at it. It's the suicide funeral or memorial service. So without further ado, I present doctor Moore. Alright. Okay. Thank you very much. It is like old home week being here right now. I spent ten years in the Washington DC area. As doctor Holman said, I was working on Capitol Hill, I worked for a suicide prevention, organization.

6:27I actually worked for two national suicide prevention organizations, and then felt led, really had kind of an epiphany. It was definitely a spiritual experience, because I had always been wanting to be on the clinical end of health care, not on the sort of policy or administrative end of health care. And, through this amazing, I would really call it a spiritual experience, the name David Jobes appeared to me and I knew he was a psychologist at Catholic University of America and so I sought him out and went to him and told him my life story and he said, Well, you have a degree in medieval and renaissance studies, so you're really not equipped to get into the PhD program, because I was saying Dante and, you know, Boccaccio, people playing medieval Italian poetry in college, but he said, come get a master's degree and then we'll see about gangstering you into the PhD program, which is exactly what happened.

7:22So I'm very grateful, to be back here in the Washington DC area. I spent all day today though working, I was I'm part of I'm an assistant professor in the department of psychology at a university called Eastern Kentucky University. We are about 20 miles Southeast of Lexington where the University of Kentucky is located. So I'm not at the University of Kentucky any longer, I did my post doc there, but I'm at Eastern Kentucky University. It's a regional teaching university, and, it's it serves very much a rural catchment area. So I'm grateful to be back though, in my home state of Kentucky. And I also do a lot of work nationally. I, sit on the board of the American Association of Suicidology, and if you have any interest whatsoever in suicide prevention, suicidology, suicide postvention, I really recommend you think about looking up the American Association of Suicidology's website, suicidology.org.

8:17It's a great organization, and we are having a conference coming up next month in Denver for April twenty fifth to twenty seventh, so I really encourage you to sort of check it out. I also am co lead for the National Action Alliance's Faith Communities Task Force, and I essentially got I was ball and told to, become co lead, not because I'm clergy or necessarily have any training, but because of the book that, doctor Holman showed you, The Suicide Funeral. There's it's there aren't a lot of people with suicide prevention expertise, suicidology expertise, who also are working in faith communities. So if you have a profound interest in this or any sort of interest in this, I highly recommend you get involved because you could very quickly have an important role, nationally, in this particular field.

9:04Anyway, but I'm here to talk with you today about how to understand suicide and its aftermath from a scientific and faith perspective. And, I'm going to be, talking about a lot of different people, but I'm so glad that you mentioned, father Rolheiser because I think no matter what your knowledge base is around suicide, your experience, your personal experience, your professional experience, whether it's a little bit or a lot, I think his quote really is very, emblematic of the experience of individuals who have had closer brushes with suicide. He said, All death unsettles us, but suicide leaves us with very particular series of emotional, moral, and religious scars. It brings with it an ache, a chaos, a darkness, and a stigma that has to be experienced to be believed.

9:52Sometimes we deny it, but it's always there, irrespective of our religious and moral beliefs. Father Rolheiser has been a real, leader, he certainly is probably the only faith leader that I know of that routinely writes about suicide and he graciously donated, a piece for our book. So I'm grateful to him, but also really grateful for his leadership on this topic. I think probably this issue, for those of us of Catholic faith, those of us of faith, probably, I don't know if people remember this or not, but this sort of came to a head, this issue, this intersection of suicide and faith, in early December, Mason Holabarger, who is a freshman at the University of Toledo, died by suicide and his parents talked with the the priest who delivered his sermon, the funeral sermon, funeral homily, and they said, you know, we really don't wanna focus on how he died but how he lived, and they made a special request to the priest.

10:53Do do do you all remember hearing about this? And actually at the funeral service, the the priest used unfortunately, used the opportunity to articulate his own feelings and thoughts about suicide, but did not honor the family's request. And the family became furious, they asked him to stop and he wouldn't stop, then they disinvited him to the graveside service. This became kind of a sort of a media campaign, the family went to the media, and it it really went viral. It was all over the world on CNN, on the BBC, I mean, it was all over the place about the family's outrage at the way the priest handled, the funeral service. I wish this were an isolated event. It is not an isolated event. I have, because I'm Catholic and I work with the Catholic Diocese of Lexington, I've had a couple of opportunities to talk with my bishop, the previous bishop to the bishop we have now, about some incidents, and I because I work with suicide bereaved people, I know of these incidents.

11:49And, here I mean, before we had our current bishop, I would I would write letters to the the bishop or I would write letters, you know, to people I thought we might be able to kind of, you know, have a conversation about what had happened, and it fell on deaf ears apparently because I heard absolutely nothing. I think that this this particular situation though speaks to the importance, particularly the the the injury, of the family and the fact that, you know, faith communities, faith leaders, people who, you know, you may be a clinical psychologist, but you also may, you know, be somebody who has a faith perspective and can certainly minister, in that way as well to people who are suffering.

12:29And unfortunately, he this this particular incident really brought up the importance of what we're talking about this evening. My I have both a personal and a professional introduction to suicide. I didn't realize it, until I got into the business of suicide prevention that I had had about three experiences early in my life, with suicide. Didn't recognize it, didn't really reflect upon it, but one of the things that I really didn't say this at the beginning, but one of the things I do at Eastern Kentucky University is I teach, I'm part of the core clinical faculty in our PsyD program, and I teach a special class called Understanding Suicide from Assessment to Intervention and Management. And the first assignment I have my students do oh, and by the way, this is a this class teaches you everything from soup to nuts, you know, history, epidemiology, theory, but then we also have embedded, clinical skills.

13:20And so I teach students the suicide focused treatment CAMS, the collaborative assessment and management of suicidality. But the first assignment that I have them do is to address what they bring to the table as clinicians with regard to suicide. And I oftentimes, I mean, this is a written assignment that only I see, and I assure them nobody else is gonna see it, and I give it right back to them so there's I don't even keep a copy of it. But one of the things that I had discovered is that a lot of the students have very profound experiences with suicide. Either they've lost family members, or they themselves have been suicidal. I've had students who were hospitalized, students that have had, you know, suicide attempts averted by family members, but very profound.

14:00So I think at first I was shocked by this, but I think it also speaks to the fact that we have to, as clinicians, we have to address, what we bring to the table and what flows from that that's both positive and negative. But in order to do that, we have to we have to, you know, really reflect upon that. And so I I have appreciated my experiences earlier in life, but then my my first professional experience with suicide was actually in the mid nineties. This is actually how long I've been around. I was working in the mid nineties as a, psychology is a third career for me, but I was working as a policy analyst and a speechwriter for the director of health in Ohio. I was working for the governor in Ohio, but appointed to the director of public health.

14:45I love public health and was working in public health for a number of years. And, on 05/16/1996, Admiral Jeremy Borda, and it probably was too long ago for many of you to remember this, but he sat in the Washington Navy yards and shot himself in the heart that morning and he was the chief of naval operations, which means he was the head naval officer for the Navy. And this was this was not, I mean, this was not a shrinking flower guy, this was a guy who had had, joined the Navy when he was 16 and he worked his way up to the head of naval operations, but he sat in the the Navy or the Washington Navy Yard and shot himself in the heart because I think it was Newsweek magazine was threatening to, run a story that he was inappropriately wearing this teeny tiny V for valor pin, which indicated that he had served in combat with valor, and they were suggesting that he was wearing it inappropriately.

15:43And so, he sat in the Navy, the shipyard or the Navy yards and and shot himself. And so this was just this rocked the public health service, it rocked the public health world, and I remember sitting in my boss's office and talking with him. And I I didn't while I worked for the director of health, I reported to the director of public affairs. And I remember our confusion around what how to think about this, why would somebody do this, you know, why would somebody kill themselves? And and the thing that mystified us is that we were, you know, our work, we dealt with every leading cause of morbidity and mortality, every behavior related cause of morbidity and mortality, whether it was low birth weight babies, obesity, smoking cessation, I mean, with mental health, but we were not talking about suicide.

16:30And so he and I could not make heads or tails of this, and we actually I remember having the conversation, you know, how do we prevent this? You know, how do we think about it? How do we prevent this? And then I remember talking with him about, well, should we be preventing this? I mean, we were so confused as to how to think about it. You know, should we be preventing people from killing themselves? And that was just how there was just a complete, you know, confusion around this topic. But my my personal, connection, my personal introduction came thirteen days later when my husband, who was a graduate student at Ohio State University, he was a chemist, he was getting his PhD in chemistry, he killed himself very unexpectedly.

17:10And this was a turning point in my life in so many respects. It was it was interesting to me that I had this sort of introduction to Admiral Borda's death and what's interesting also is that I came I remember coming home that night because I was still talking about it at the tail end of the day. And I wanted to talk to my husband about Admiral Borda and he would not engage with me in conversation. He would and he was an academic, he was an intellectual, he had something, a comment to say about everything in the world, but he would not engage with me on this topic. Of course, now I understand why, because he was, himself, was thinking about it, contemplating it. But this was without a doubt the most emotionally and physically painful experience of my life.

17:54I do not think I I I cannot conceive of ever feeling that much emotional and physical pain. And it changed me in a very profound way. One of the things that I experienced was, whoops, somehow it's not popping up. I don't know why. Okay. How do I go back? Let me go back here. Let's see. I don't know how to do this. Something's not popping up. Okay. How do I go back? Do I go back? I don't know. Something maybe there's some sort of I'm trying. Yeah. No. But others experience what I experienced. Okay. Apparently, it's not gonna show up. So what I experienced was incredible professional and personal rejection. So my husband was not American, he was Irish. He died on a Wednesday. I was on a plane on Saturday with my aunt and uncle, who were sort of like my surrogate parents, taking his body back to Ireland for burial.

18:53We buried him on Monday. We were back on that plane on Tuesday, and I was back at work the following Monday. And I realized when I came back to work that something different was going on. There was something about this experience. I shared in the taint of what he had done. Now here I was working at the, you know, top of of of public health agency in a in a big state, And people were normally very happy to see me in their offices. I mean, because I was usually going to be, you know, writing about something wonderful that they had done, or you know, promoting whatever, you know, cause they were involved in. But when I would see people, they were clearly not interested, you know, after I came back, they were not interested really in coming to their office.

19:30Certainly, people were not coming to my office. And in fact, I would be walking down the hallway, and people would see me coming, and they would turn and walk in the opposite direction. There was enormous, professional, isolation and rejection. Also, my family had no interest in talking about this. My friends had no interest in talking about this. So enormous, personal rejection. Also, sense of being blamed. The newspaper, because my husband died in a very violent way. He died of self immolation. And, the newspaper, the local Columbus Dispatch, wrote a piece on on how you know, his death. And, of course, they went around and, you know, interviewed all of my neighbors, and they were trying to figure out why would this happen.

20:10And, of course, nobody knew, so, of course, they blame the wife. You know, that's what happens. In text citations. That's what I'm supposed to say here. And I'm happy to send you my slides if you'd like to know what they are. But I realize that I was not alone and this was actually an experience of of many suicide bereaved individuals. So as I said, this was a profoundly painful experience and it changed me. And I oftentimes tell people it was the worst experience of my life. But I also tell people it was the best experience of my life. And that may seem absurd, but I will have to tell you that it really took the blinders off. It changed me on a profound level. It made me more compassionate.

21:25It certainly changed my voc my vocational interest. I would survive almost anything. It certainly made me, a more deeply spiritual, faithful person. Faith was really, frankly, the only thing I had Because no one else wanted to talk to me. No one might, you know, God loved my priest, but he said to me, you know, I said, would be great to have a faith support or some sort of support group for people who have had losses. And he said, well, you're the first person that's ever said that to me. And so I there were my doctor, my therapist, nobody knew how to talk with me. But what I did have was going to Mass once a week and suffering with Christ on the cross and taking the Eucharist. And so it was the one place where I could grieve.

22:28And so that's the one thing I did have. So one of the things that I realized later was that this is actually a concept called post traumatic growth. I don't know if you all are familiar with this phrase post traumatic growth, but it was actually, like the new science of suicidology or suicide prevention, post traumatic growth has been something that's been around forever. I mean, it's in every major world, religion, philosophy, it's in the Bible, but we've only begun studying it since the mid nineties. The phrase was coined by Tedeschi and Calhoun, and, there's a measure called the Post Traumatic Growth Inventory, but really this idea of post traumatic growth from trauma is something that stands on the shoulders of Viktor Frankl's work in Man's Search for Meaning.

23:10I love this quote. May rise above himself, may grow beyond himself, and by due This really changed also, this being being introduced to post traumatic growth really also changed me professionally. If I can get this to forward, I'm hoping it's going to forward soon. Maybe not. Okay. Maybe not. Did I do it? Okay. I have to go back again. I don't really want to go back. I'm not a big lover of technology. Okay. Well, there we go. Now we're back to Victor. Okay. So I was actually the first researcher to look at post traumatic growth among suicide bereaved parents. You know, when I first came to Catholic University of America and met David Jobes, he's a, you know, he's now a suicide treatment researcher.

24:03And he was really a suicide assessment person at the time, and then he developed this wonderful treatment framework, and now he's a suicide treatment researcher. And so it's interesting because, when I when I came to him and was working on my PhD and thinking about my dissertation, I automatically thought that my dissertation topic would have something to do with his suicide treatment research. And he said to me, he said, You know, Melinda, you're really in love with this concept of post traumatic growth and you're suicide bereaved. And he said, when you think about people who grow from trauma, he said, I can't think of another suicide bereaved person who kind of fits this profile of somebody who's grown from their trauma.

24:38And he said, why don't you look at that? Look at because my first reaction was like, oh, no. I'm I'm a researcher now. I'm not a bereaved individual. And I have to tell you, I was so ashamed of my reaction. It made me realize that I had internalized the stigma that is so that is so great in our culture. It's it's everywhere in our culture around this topic of suicide. And I thought, you know what? Nobody knows more about this from the inside out than me, and I really should be doing something to help suicide bereaved folks, because it's such a miserable experience of loss. Giving them hope and doing some research to see if there if indeed it's possible to grow from this trauma. And so actually, this is while I do suicide prevention research among my college, my university, involved in, you know, sort of clinical treatment, my real love in terms of research and sort of the area of research that I do primarily is is post traumatic growth research.

25:40And so I've looked, at I've gone beyond suicide bereaved parents. I now embed this in everything I do. And I've I've worked looked with military samples, doing all sorts of, you know, sort of evaluations of organizations from a post traumatic growth perspective. So this really has become sort of my anchor in terms of my research. In terms of I mean, apart from sort of anecdotal, you know, stories around the impact of this kind of loss, you know, we think about the sort of the breadth of this loss and also the fact that, you know, like I said, post traumatic growth is something that we've had around for, you know, years and years and years, but we've only begun to sort of quantify it and look at it more as a scientific kind of construct.

26:25Suicidology and suicide prevention research is also fairly new. The the term suicidology, the study of suicide is in the in the community, the suicidology community is only about 50 years old. So it's a pretty new area of science. So when I talk about the science of suicide, I'm talking about sort of this general kind of new science. And so part of this new science is really getting our hands around numbers. Sort of the, you know, data collection part, getting coroners to more accurately report suicide deaths. This has been a real problem in our country. Having good data collection, having states that are really engaged in getting more information around individuals who die violently by suicide, you know, getting information on the circumstances.

27:07So this is something that has is also relatively new in terms of getting our hands around the impact. What we know is that over forty seven thousand Americans die by suicide every year in The United States. It's the tenth leading cause of death. And the the real problem with this is that the other nine the the other 10 leading causes or the other nine leading causes of death are fairly, static. But suicide is still fluid. We're seeing increases every year. Now is that because of better data reporting, or is it increasing? We really don't know, but it's it's pretty scary, frankly. We know that individuals, primarily males, are dying by suicide. That's because they tend to use more lethal means.

27:51You all probably know that. You know that, probably also that women attempt suicide more frequently, but men are dying because of the lethal means. Another thing I also wanna say is about nomenclature or language. You know and one of the things that the suicidology community has done is really developed more sensitive, language around suicide. So instead of and I I train all my students to try to remove the term committed suicide or committing suicide from their vernacular because what we now know is that a lot of not only does it add to the stigma and the lack of help seeking for suicidal individuals, but it really stigmatizes those individuals who have who have died by suicide and also stigmatizes the families.

28:35So when you're working with suicide bereave their end of the age spectrum. So either those who are young, 15 to 24, adolescents and adults, and then those who are older, 65. But since 2010, we've seen an increase in people in the middle of their lives. So individuals who are, you know, 35 to 64 years of age. And there's been a lot of question, like, why is this happening? Well, the data for suicide tends to lag to two years. It takes two years. So the 2017 data is the most recent data that we have because it lags about two years. But what we realized about 2010 data is that actually, in 2008, economic downturn, that was probably one of the drivers for the increase in suicide. But there's also some thinking about cohort effect.

29:39Is this a cohort perhaps that uses more drugs and alcohol? You know, they're more sort of risk taking. And in fact, a lot of, a lot of scientists have looked to Robin Williams' death as sort of an example of this uptick in people in the middle middle of their lives. We know that over a million Americans attempt suicide every year. Nearly ten million Americans nomenclature, we call, individuals who have attempted but survived, we call them suicide attempt survivors. And then those individuals who have lost loved ones to suicide, we call those suicide loss survivors or suicide bereaved or suicide survivors. So like I said, there's a whole language around this, but I think it's important to kind of use the right language.

30:22Otherwise, you know, we kinda don't know what we're talking about. But he wrote a mainstream book, which I think in and of itself was just brilliant, to get at a larger group of people. And while it's, a little bit dated, 2005, this Why People Die by Suicide really beautifully describes his theory. And the theory goes like this. There are generally three things that make suicide possible. There is this perception of no longer belonging, and we call it thwarted belongingness. So a person feels like they're alone. So if you think about a combat veteran who's coming back from combat, and they've been away for, let's say, a year, and they feel disconnected from their family, from their social organizations, from their children It's called Calm Counsel lethal means.

31:10It's through the suicidepreventionresourcecenter.org, sprc.org. And there's also another really great resource at Harvard University called Means Matters. Means Matters, I think it's .org. Really wonderful resources to help clinicians learn how to talk with individuals about means safety. We also have uncovered over just the past couple of years, you know, when we think about standard of care, standard of care in working with suicidal individuals is what? What's typically done? I mean, I work with a lot of clinicians out in Oklahoma, and when they hear, I train I've I've, like, trained tons of clinicians out in Oklahoma in CAMS, because the entire state of Oklahoma is being trained in CAMS.

31:49But what do they do out in Oklahoma when somebody says suicide to them in in the therapy room? What do they do? What are they? What what were you gonna say? Well, yeah. Medicate hospitalization. Oh, no. You gotta stop right there. Shut them down. We're going to hospital right now. Or they immediately will hospitalize them. There's no discussion beyond, you know, or medication. Medication only approaches. So standard of care currently is hospitalization and using antidepressants. But the problem is this new science of suicide has suicide prevention has really taught us that there's limited or mixed evidence supporting medication only approaches in managing suicidal risk. And also, there's zero evidence.

32:31Marshall Linehan loves talking about this. There's zero evidence to support inpatient psychiatric care for suicide risk. In fact, there's, new evidence to show a cumulative risk conferred by repeatedly hospitalizing people. So one of the things I do is I train my students, if you're gonna hospitalize, do it judiciously. You don't do that as sort of a first, you know, reaction to somebody being suicidal. A part of this new science of how to understand suicide, so not just sort of the clinical treatment, but the impact of suicide. It's not just the numbers, then, you know, capturing better numbers, but also understanding who is really impacted by these experiences, by these by these particularly very public deaths.

33:16So when you think about, you know, Anthony Bourdain and Kate Spade, I mean, I had just gotten back from from Ireland the day before Anthony Bourdain died, and I used to DVR him. I loved him. And my husband and I were in Ireland together and we had multiple conversations about wouldn't Anthony Bourdain love this meal, wouldn't he just love, you know, like all of these things. And I remember when I got off the plane and came came home the next day, I was thinking, I can't believe he's gone. And I didn't even know him, but I felt deeply impacted by his death. And so it's it's confusing, these deaths, you know, and the impact they have on people. So so I was actually part of a research team that looked at instead of looking at people, you know, we typically have thought about the impact of suicide being more about kin relationships, you know, blood relationships.

34:02So we've looked at, you know, the family, the mom, the dad, the siblings, the spouse, the children of but we really understand, survivorship or the impact to be more on a continuum. So you've got individuals who are suicide exposed. Then you've got individuals, sort of as a part of that, people who are actually affected by the death. And then as a part of that, you've got people who are suicide bereaved, both short and long term. And when you think about the potential types of individuals in each category, you know, these are individuals we we don't typically don't think about. So if somebody kills themself in a hotel room, what about the maid who finds that that person? And and they that's probably not the first person that they found, or first responders, or let's say that person's therapist or their doctor, you know, people that they went to church with, people that they were in sporting, you know, clubs with.

34:54But like and in my case, you know, with Anthony Bourdain, you know, I was just a fan of his, you know. So that really the the the broad numbers of people that can be considered suicide exposed is, you know, people that we really didn't think about previously, we include, we include in that category. And people who are affected, we find them to be slightly, slightly closer in proximity. So there's a sort of a perception of closeness. So I felt like I knew Anthony Bourdain, but I really didn't know him. But somebody who might be affected by his death would be, got a first responder, you know, his therapist, anyone who discovered the body, you know, classmates, coworkers, all of these kinds of people.

35:32And then, of course, suicide bereaved, short and long term, would be again these same people, but those who felt either close or very close to that individual. So I suspect, Eric Rippar, who was Anthony Bourdain's best friend, who also found his body, I cannot imagine how devastated he must be. And he certainly would be in the suicide bereaved short or long term category for sure. But the one thing I think we have really underestimated is the impact of patient death on therapists. The American Association of Suicidology has a wonderful task force called the Clinician Survivor Task Force, and it was created, it was originally created for clinicians who had family members who died by suicide, but now it's really being used for clinicians who have had patients die by suicide.

36:17And they need some place safe to go to talk about their feelings of loss, of feeling responsibility. And so it's a wonderful, wonderful resource. What we found, on the study team that I worked at the University of Kentucky is that suicide exposure, just by being suicide exposed, it actually confer, it it it, people who have been suicide exposed have higher levels of both depression, anxiety, suicide attempt. There was a study done in England that showed, college students who had been suicide exposed and felt close to the individual, actually had higher levels of suicide attempt as well. We find that closeness is also associated with mental health symptoms among suicide exposed, not just depression, but PTSD and also prolonged grief.

37:04What we found in this study was also pretty remarkable, because for years and years the suicidology community, they kept touting this number that for every person who died by suicide, there were six people who were profoundly impacted. Well, there was actually no empirical support for that whatsoever. They just adopted it from actuaries who calculated the numbers of individuals who were impacted by deaths when an airline crashed. And so actuaries came up with the number six. There were six people who would get a death payout. And so we just took that number and said, okay, we're gonna use it for, you know, for our population as well. And actually, there was no empirical support. So actually, our study did very sophisticated, calculations, statistics around this, and found out that for every death by suicide, there were a hundred and thirty five people who were exposed.

37:50They'd be in that exposed category. But then about thirty percent of those individuals felt close or highly close. So forty eight of the hundred and thirty five actually felt close or highly close, and they themselves may need intervention or services. So those would be the individuals who had depression, anxiety, and suicidal ideation. You know, I think the issue though of faith, so when we think about, sort of, the breadth of exposure and the individuals who really are feeling, you know, very confused about how to, how to process this or think about this within the context of their faith. You know, I think about about, E. Betsy Ross who wrote this book, it's a little bit dated, called Life After Suicide.

38:28And, you know, she writes about the fact that she was ambivalent about praying for her husband's soul. But it was her pastor, Pastor David, who really provided her comfort reassuring her, encouraging her to pray for her husband's soul. And he reminded her that the early Christians prayed for the souls of those departed Christians, who had killed themselves to avoid Roman torture and assassination. And the fact that the stigma around this stigma, you know, promulgated by the church, really only occurred later. K. Redfield Jamieson also writes in her beautiful memoir, Night Falls Fast. You know, she writes about her suicide attempt and, she also asked, you know, where was God in all of this? You know, where was God?

39:09Where had he been? And she also writes about the healing effects that can come from a really caring ministry. So she also makes, as a scientist, as somebody who's a suicide attempt survivor, writes about this beautifully. My friend Kay Warren, I don't know if you all know who Kay Warren is. Her husband wrote, she and her husband wrote the book The Purpose Driven Life as Rick Warren. She's the co founder of Saddleback Church. I was actually with her today at the National Action Alliance's meeting, and she and I were talking. I was telling her I was gonna be here tonight. She was really excited, because she lost her son Matthew six years ago. It'd be six years ago next month to suicide. And this was this is a devastated mother.

39:46This is a woman who has been traumatized by her son's death. And she said so beautifully last year at a talk she gave at the American Association of Sociology Conference. She said, surviving my son's death was barely survivable with my faith. Without it, I can't imagine it being survive, survivable. She also says that you can't live without hope. I knew that somehow, some way, I was going to have to rebuild hope. My son died by suicide. How could I rebuild hope in the face of losing him in that way? And you know, her words, and by the way, she and Father Rolheiser did this beautiful video together called Reclaiming Life. This is a picture of it right here. And I would encourage, you know, maybe your department to get this video and, you know, have it in the library or, or in the collection, because it really speaks beautifully to this, the importance of faith, and the, and within the context of these, horrible experiences, and the necessity of faith leaders and clinicians who have, you know, who are of faith, really being willing to talk with individuals who are suffering greatly.

40:53And I would have to say it it this really resonates with me because I don't think I had a resource available to me other than my faith in the wake of my husband's death. So, you know, I really encourage all of you who are who are in this business to really, you know, think about, maybe, you know, getting some specialized training or reading more or watching videos or just really kind of digging deep to become competent to talk with individuals about their experience of loss within the context of their faith. And we think about, you know, the church and the church's contribution to sort of this stigma, you know, for the better part of two millennia. The church has contributed to, the stigma.

41:31It started with Augustine, you know, who equated the sixth commandment, thou shalt not murder to suicide. And, of course, Thomas Aquinas wrote and argued against suicide. Others though have also suggested that, you know, while the the Bible doesn't really directly say anything about suicide, in fact, the sort of benign representations of suicide in the Bible, you know, others have said that Christ never recommended it. Christians should live by faith and trust God. It that it cuts people off from the possibility of repentance and, in fact, there might be some sort of diabolical, you know, possession. And, of course, you know, for for, you know, centuries people were not allowed to be buried within, you know, church cemeteries.

42:13Although that changed with the advent of Vatican two. Also Protestants, I mean, there was a lot of social stigma that really reached its height in the Middle Ages. You know, leading reformers continued to argue against suicide. In fact, John Wesley, wrote the thoughts on suicide. He saw suicide as really the, deserving the harsh, harshest of measures and severe punishment. He thought this was a sort of a good thing. The current Roman Catholic view, I don't know, I mean, I'm sure many of you have a, probably greater knowledge than I do of the Catechism of the Catholic Church. But how I understand it and how a lot of individuals, who are Catholics or people of faith, who study suicide prevention, we understand it this way, that while it is it is considered a sin, it is also not an act of free will.

43:00And because it's not an act of free will, there is a diminishment of responsibility. And, of course, you know, as culture has progressed along and we begin asking, you know, these questions of ourselves, where is God in this? We also like to believe that, you know, God is, a forgiving, compassionate God And that God could not possibly condemn our loved one, much like Dante did, you know, to, he, you know, condemned decedents to, to the inferno, that God does not do that and understands. And so I think that a lot of this sort of ongoing, you know, punishment of individuals who are suicide bereaved, you know, at these funeral masses and then the decedent themselves. I think that this is something that, we have to really address.

43:45And one of the things that I'm doing with the National Action Alliance is really pushing the Faith Communities Task Force to do much more training of clergy, bringing them in because a lot of clergy have no idea that they are really in a position to, not just minister but also provide good information to people. People would rather talk to their clergy member about their mental health issues than a mental health professional. So they are really in the perfect position to be talking if they are competent to do so. Father Charles Ruby is also, along with father, Ron Rolheiser, is somebody who's been engaged in suicide prevention efforts and outreach postvention efforts to suicide bereaved for many many years.

44:24For over forty years, in fact, he's run the loving outreach to suicide survivors of suicide in the archdiocese Chicago. And he says, there are still some priests who view suicide as a mortal sin. That has been categorically denied by church leadership. He said, it is critical to the healing process for priests and church leaders to talk openly with parishioners and avoid fear mongering over the church's view of suicide. So So I think this is a discussion that we all must have and as Catholics and as people who, care deeply about the suffering of individuals with mental illness, you know, people who are suffering there are many roads to Rome. And, only about fifty percent of people who die by suicide actually have a diagnosable mental illness.

45:05So it's a behavior that is also engaged in with a lot of people who just have very limited repertoire of problem solving skills. So So I think we have to have conversations open and candid and informed by science conversations about this topic. Somebody who really, was important in my path, to doing what I'm doing today was Reverend James Clemens. He was actually an Emeritus Professor at Wesley Theological Seminary here in the DC area. He was a Biblical, scholar. He was also an ordained Methodist minister and he founded an organization years ago in the dark ages of suicide prevention called Organization for Attempters and Survivors of Suicide and Interfaith Service. But really the first organization that addressed this issue and this intersection of faith and suicide prevention.

45:52He also wrote a lot of really nice books that are still some of the only ones that exist, such as What Does the Bible Say About Suicide? Sermons on Suicide. Also Children of Jonah is about suicide attempt survivors. Beautifully written. And he and I were actually writing this book together, the suicide funeral, honoring their memory, comforting their survivors. This started a long time ago, and, he was unfortunately killed. It was an accidental train accident up in Gaithersburg, actually. And, so I had to shelve this because I was in the middle of my training and, I ended up meeting Rabbi Dan Roberts, man of faith, man of God, also suicide bereaved. He lost his father when he was 10. He is also a thanatologist, so he is very well known in the thanatology, the, you know, the death studies area, and has, was sort of like the go to rabbi for people who were grieving or grieving suicide death and became an, a kind of a national leader in, in that community.

46:54So he and I actually ended up finishing the book and this book is really to address the dearth of information, the dearth of training among seminarians and clergy. You know, most clergy don't get any kind of training if they've gone to seminary. And, it's my understanding I'm not clergy, but according to clergy members that I know, including Rabbi Dan, the suicide the funeral of an individual who died by suicide is one of the hardest sermons to ever formulate. And so the idea with this book was to develop, template homilies and sermons by a broad range of faith perspectives. So we have not just Catholic, but Jewish, Buddhists, I mean, Methodist, Baptist, every every, every faith is represented in this book with the exception of Greek Greek Orthodox.

47:40And that's because, there is a disagreement. Greek Orthodox, they really, do not, policy wise, are not in agreement with most faith perspectives, and so we just chose not to include that. But the idea is to give clergy and and seminarians some idea about how to perhaps, manage this issue. And also, it it gives a lot of good sort of recent science information. How do you think about this from the scientific perspective? Also issues of self care and postvention. But also perspectives written by a broad range. So we've got sort of opinion editorial type pieces that are written by these, faith leaders as well to to sort of speak to clergy and seminarians, about how to think about this topic. One of the things that we're finding is that it's not only helping, clergy and seminarians, but it's probably helping suicide bereaved people as much as anybody else.

48:34People of faith who have nothing out there. So those of you who are interested in writing, care about this topic, and, have, a degree that will, such as clergy member, you know, you will have, you know, an endless opportunity to write about this topic, because there's certainly a hunger and a need for this. I'm also part of, like I said, the National Action Alliance's Faith Communities Task Force. National Action Alliance is part of the advent of this kind of cultural shift toward thinking about suicide, from a more scientific perspective, but then also enacting public policy. This, emerged out of an early blueprint that was created for suicide prevention in America. It's now a public private partnership.

49:17And like I said, one of the task forces, the Faith Community Task Force. We have this wonderful website. I would encourage, you all to visit the FaithHopeLife. We actually have a new website, and we do a variety of things. One of the things that we do is we we really wanna give faith communities and faith leaders resources. So how do you respond to a member who's at risk for suicide? How do you respond to somebody who's had a loved one die by suicide? We provide worship and spiritual resources, bulletins, flyers, things like that, other resources for mental health promotion. So Kay Warren was talking today about what they're doing now at Saddleback, and they actually have monthly meetings to talk about mental health issues.

49:57And they bring in hundreds of people to these meetings, kind of just providing support to individuals who are struggling with mental health issues. We also have, this this next September, will be the third annual National Weekend of Prayer. One of the things that we realized faith communities did, we all had in common we all had in common is we pray. And so we the idea was to get faith communities and joined in this effort. So now we, we have a campaign called the national weekend of prayer, which encourages all faith perspectives, whether you worship on Sunday or worship on Saturday or worship on Friday, to pray for individuals who are at risk for suicide. And then also to pray for those individuals who have perhaps lost a loved one to suicide.

50:39So I would really encourage you to go on the website and check this out. I am really lucky to have a wonderful faith leader in my community, Bishop John Stowe. Unlike other previous bishops, I have to be honest with you, who did not respond to my letters or my pleas or my phone calls, Bishop John Stowe has been an amazing ally. He really has. And, I I get emotional talking about him because, it would be such a it would have been such a wonderful, boon to me personally to have somebody like this around when I first had my experience of loss. But he actually did not only did the entire diocese, he pushed out this material about the National Weekend of Prayer, and they're doing all that they can possibly do within our diocese to sort of raise this issue, to to create, you know, opportunities for people who are suffering, either suffering with suicidal crises or suffering from loss.

51:37But he also did a beautiful homily on World Suicide Prevention Day. And I was stunned, and it was just beautiful. So I'm very grateful. And I just want you all to know that even though, you know, we've got a lot of work to do, there are some there are some faith leaders who get this, and they are certainly models for everybody else. And so that is I appreciate your all's attention. I thank you all so very much for coming tonight, and, let's open up to questions, I guess. Any questions or comments or thoughts? I gotta be honest with you. I was a little worried about speaking with you all tonight, because I thought, oh my gosh. These people know the Catechism better than I do. They know they know their stuff.

52:32Yes, ma'am. Well, definitely comment. I just wanna thank you so much for your talk. This was so helpful in so many ways. So really thank you for sharing with us your story and giving us hope. Mhmm. Moving forward. Mhmm. Yeah. Thanks. Yes. I'm actually from Kentucky too, so I just wanna say pull over from home state. Yeah. Where are you from? Where are you from? Lawrenceburg. Lawrenceburg. Yeah. And you're Frankfurt. Yeah. So, my question is being aware that so many people, do have suicidal thoughts and such a taboo topic in a lot of ways. How can we be aware of the people around us and respond in ways when we make them feel comfortable to talk about it if they're having suicidal issues? So this is the thing.

53:25And I there's so much to to convey to you all, and there just wasn't enough time. There are so many myths around suicide, and one of the big myths is that if you talk about it, it'll put the idea in their heads. It's kind of like people who say, you know, like, it's kind of like the idea about kids and sex. Like, if you talk about it, it's gonna put it in their heads. Well, sorry folks, they're they're already thinking about it, you know. And what we know about suicidal people is they've been thinking about it for a very long time. There's a a lot of talk about suicide being an impulsive act. Actually, there's a lot of evidence that kind of new science of suicidology, suicide prevention, it's not it's not an impulsive act.

54:02In fact, Thomas Joiner, he wrote a fabulous book, not not only why people die by suicide, but he also wrote a great book called Myths of Suicide. And in it, he talks about some of the myths. One of them being it's non impulsive, and he has all the science around that. But also, talking about it is not gonna make people think about it. In fact, what it's gonna do is how you, you you know, it's not just what you say, but it's how you say it. How you convey kind of non judgment, sort of an open, you know, attitude, you know. Asking somebody, you're not thinking of suicide, are you? You know, what does that convey to them? Not thinking about suicide, are you? Yeah. Yeah. Shame, shut them down. They don't want you don't really wanna know the answer.

54:44But asking the question, are you having thoughts of suicide? You know. And then talking with them about it in kind of a non judgmental way, like you're trying to solve this problem, uncover. You're curious with them about what's going on. You know, I liken suicidal thoughts to kind of having a sore throat, and you have other kind of upper respiratory symptoms. And you're thinking, yeah, should I go see the doctor? Should I go see the doctor? And then you feel you feel worse. You feel more congested, and you start having a temperature. You're like, okay, I'm gonna go see the doctor. To me, suicidal thoughts are like that. They're not gonna kill you, but it certainly is a red flag and indication that you need to see a professional.

55:20Somebody competent to treat that person. Not somebody who's just gonna say, oh, we got to take it to the hospital. Or, oh, here's a prescription. You know, somebody who's really willing to sit with you in the distress that you're in, and explore why you're suicidal. So I would encourage just training. Getting trained in CAMS, getting trained in CALM, so you can talk with people about, you know, access to lethal means, you know, means safety. Just getting real with people. Yes. Mhmm. So as someone who's dreams Mhmm. How do you, I guess, watch out for how these dreams are affecting them and whether they're able to cope? That's one of the reasons I do this exercise, because I wanna be able to monitor and check-in and find out.

56:13So most of these experiences are long ago. They're past. I mean, they've worked through these issues or they're in therapy, you know, I mean, I encourage them to be in therapy throughout their training. But they've usually worked through many of the issues that put them at risk. We did have a student last year. She was a school psych student. We have a school psychology program and they also, the school psychology graduate students take my class as well. And, we had a school psych student, one of them who was recently suicide bereaved, and she came to me before the class started and said, I don't think I should take your class. I just can't talk about this issue. And I said, actually, I think this is the perfect time to take this class.

56:49And at the end of the semester, she thanked me. She said, you're absolutely right. I'm not scared of this issue anymore. I've had to address my own feelings, my own feelings of loss and overwhelming grief, And now I know how to talk with suicidal students about, you know, what's going on without my fear that my own stuff get in the way. I had another student who was actually having suicidal thoughts, and I was able to get her some help. And it, it, it kind of the same thing. It was, we were able to help her and get her, you know, the help that she needed at the time. But it's, it's rare that it's currently going on, but sometimes things get triggered. So I like to know where kind of the risk is in the class so I could check-in with people and that's why I do it.

57:25Yeah. Yes. I don't, you know, I I think, I don't know that I can competently address this, because I, I don't I don't think I have the training that allows me to have the language. I can only talk about my own experience. I think if I just wasn't in need of that support, given the fact I mean, what was what was the alternative? I know in my situation, I had no alternative. This was what gave me hope, gave me sustenance, allowed me to suffer, allowed me to marry my suffering with Christ on the cross. It was the only thing I had. So I I I I guess I'd never even, thought about the spiritual trauma of it, because it was the only thing I had. Yeah. I don't That's probably not a very good answer, folks.

58:33Sorry. Yeah. Yeah. Yeah. Sure. Yeah. I I wanna echo what some of the welcome and the gratitude. I really appreciate this talk a lot. And amidst it, this is my first exposure to someone, who is a suicidologist. Mhmm. And it was very eye opening in a lot of ways. Some of my research has touched on the public policy side of physician assisted suicide, especially we as mental health providers. Our role of the the dubious ethics of our of our potential participation of the law sort of Mhmm. Requires mental health providers, mental health providers, a couple of mental health providers in certain states to sign off on assisted suicide. Thinking about what you've shared with us and specifically your work, on the national level for suicide prevention, where does where does that very sticky hot button topic of physician assisted suicide, where does that fall?

59:41This is you have but yeah. You've hit the nail right on it. Really sticky and really hot right now. Your hand or his body? No. Really sticky and really hot right now in the suicidology community. I will tell you, historically, suicidology has seen physician assisted suicide as separate from suicide. But I think more recently, the implications, you know, of sort of living in a culture of death that's more death oriented, you know, life is just, you know, sort of disposable. This has been an issue that has been raised, and there are some definite profound camps within the suicology community. And I will tell you, Thomas Joyner, the guy who wrote Why People Die by Suicide, is amazing researcher, you know.

1:00:22I mean, when when I raise the issue of faith in suicide, prevention, most mental health people kind of shriek and go, oh, you don't wanna go there, you know. But, and the interesting thing is Thomas Joyner is, he's, an atheist, I think. Think. He's an atheist or he's agnostic, one or the other. But anyway, he feels profoundly that we are on a slippery slope. And he is, he is definitely opposed to physician assisted suicide. And so he wasn't predictable, sort of, his thinking about this, but it also tells you how people are in our community are thinking about this very, very differently. So I don't know that we've come to any consensus whatsoever, but there are definite camps. Yeah. Thank you.

1:01:02Sure. Yes, sir. Yeah. Did you have any thoughts about the distinct Oh, yes. Oh, yes. I'm a I'm a CAMS clinician. I'm a CAMS clinician, and this is part of our CAMSian philosophy. Yeah. We don't treat a diagnosis. Well, number one, we're treating a human being. Right? Okay? But we also don't this is sort of part of the new science of suicide prevention, suicidology, suicide treatment. For too long, clinicians have treated the diagnosis somehow thinking that suicide stuff's gonna go away. They see suicide as a symptom and a constellation. And so if you treat the bipolar or the depression or the anxiety it goes away. Well, that's not the case. Actually, you have to treat suicide as a targeted treatment, and that's what CAMS does.

1:02:10So, yeah. Do you agree? I do. Yeah. I studied with the the Oh. So When was this? Three years. Did you and I communicate? We did. Did I put you in contact with father Corbett? You did. I did. Well, it's so good to finally meet you. Yes. You met you in person. Yes. It's so good to meet you finally in person. Yes. Okay. Yes. Yeah. So a couple of things come to my number one. There were there have been three suicides on the campus of University of Kentucky. Like I said, it's not my university, but it's the one to the north. I've actually been to the the parish that serves the University of Kentucky community. I've actually been there a couple of times to speak in the last six months. And, one of the things that they have done is they do I mean, they do some I wouldn't say mental health ministry, but they definitely make people available.

1:03:28They're very attuned to the community. I think you have to and I did a a what we call a postvention for the parish, where people came in who were who were I went to school with the individuals who died or the one with the person with the faculty member, people who were impacted, who were exposed and impacted by the deaths. So we we just talked about the issue of suicide and the impact. So you kind of raise it generally, but there are also these wonderful things called gatekeeper training. If you all have heard of this, question, persuade, and refer is one of them. There's also assist. I think these are really wonderful training. And I I personally think, like, everybody, you know, should be trained and have gatekeeper training.

1:04:08We also do this at my university, EKU, where we provide it to entire you know, we're trying to get the entire university, 16,000 students trained in in question, persuade, and refer. And gatekeeper training really gives some very basic skills, you know, listening, what to look for, what to say to somebody, and then, you know, ideas about, you know, kind of getting access to people who are professionals, not leaving them alone. So I think gatekeeper training is wonderful. But I think when it comes to children and adolescents, this is also a very special sort of problem. And I think schools need to be doing a better job. I know in Kentucky, they have this absurd, they have these absurd, whatever state laws that are unfunded, unpoliced, where they have they've got a requirement to mandate, I think, that all high school students have to take one hour every fall on suicide prevention.

1:04:58And it's literally something that the principal has gotten off the Internet. And so then we'll take to the to the, student, like, the auditorium, and they could gather all the students together and they talk with them about suicide. And some of the scary things that I've heard well, number one, there was a child who thought that went home and killed himself after one of these, school presentations. But also, a colleague of mine, her niece came home one day and said, hey. I learned seven new ways to kill myself today. So very unsafe messaging through some of these large, you know, endeavors. I think you have to get people who know what they're doing involved. So Ohio has a wonderful hospital in Columbus called Nationwide Children's Hospital, and they're very engaged in providing school districts with something called, signs of suicide, gatekeeper training, where they train everybody in the schools, and they also help the the students, you know, look for the signs of suicide and what to do when, you know, one of their peers is perhaps at risk.

1:05:53So I think gatekeeper training is really important, but also, you know, people in a community need to just not respect people's privacy so much. I know that's the one thing that I realized right away. I respect my husband's privacy a little too much. I will never make that mistake ever again. And but I think we need to show get beyond ourselves in terms of caring about people and saying, you know, you don't see them yourself, or you haven't thought of suicide. So really getting beyond that kind of fear of of talking about suicide and calling it what it is. Probably a long winded response, but I think you raise a really important point.