How to Talk About Suicide: POV from a Suicidologist

hand of person drowning sticking out of the water

Written by: Where Parents Talk Staff

Published: Sep 26, 2023

by Katherine Martinko

“The risk of not asking is so much greater than the risk of asking.”

Dr. Stacey Freedenthal makes the option starkly clear. The psychotherapist, suicidologist, and associate professor at the University of Denver, wants parents always to take the time to ask whether their teen might be having suicidal thoughts, even if it feels like an awkward or upsetting conversation. “There is never a perfect time… and you don’t have to ask the perfect way.” But the mere act of inquiring can open the door to a life-saving conversation.

Click for video transcription

Welcome to where parents talk. My name is Lianne Castelino. Our guest today is an associate professor at the University of Denver, a licensed clinical social worker, and a psychotherapist, Dr. Stacy Frieden vault is also a suicide apologist and author and a mother. She joins us today from Denver, Colorado. Thank you so much for being here.

Thank you. Thank you for having me.

Dr. Freedenthal, your interest in Suicidology really stems from a series of experiences that you had, as a teenager, encountering people you knew and people you did not know who had taken their own lives? Why was that a catalyst for you to pursue this area of study and of specialty.

It’s interesting, I mean, I, myself also had suicidal thoughts as an adolescence. And then in high school, there were two suicides in my high school in my grade, within five days of each other. And the second, the first person I did, didn’t really know. But the second person I did know when I was with him, up until the night he died. And I don’t mean I was with him every day. But you know, I, we hung out together, and we were at the party that night. And I remember just being so blown away and wondering why he didn’t tell us and why he didn’t get help. And that’s what I ended up doing my doctoral dissertation on was adolescents getting professional help when they have suicidal thoughts.

Along those lines, you have been studying this and been exposed to this topic. For almost 30 years, can you describe how much this whole field of study has changed, let’s say in the last 10 decade, and specifically since the onset of social media.

It’s definitely changed a lot of it even well, before 10 years ago, but then the beginning of this kind of suicide prevention field, there was a belief that you have to be a professional to talk with somebody about suicide, you know, about suicidal thoughts. And I spoke with an older gentleman who said, like when he was in the 60s, I mean, when it was the 60s, and he was young, he was instructed don’t ask, you know, he was a case manager don’t talk to the clients about their suicidal thoughts. Only psychiatrists and psychologists can do that. And fast forward about 40 ish year, the surgeon general issued a call to action for suicide prevention in the early 2000s. And the report listed people who can help prevent suicide, and they listed bartenders, they listed hairdressers, you know, they enlisted neighbors, I mean, so really, everybody can play a role in helping someone who has suicidal thoughts. Know, you don’t want to be recommending Medicare, certain medications or, you know, doing a full on risk assessment if you don’t have the training for it. But there’s something that you can do just as a family member, or a friend.

Before we get into some specific examples of how parents can help a child who might be having suicidal thoughts. I’m curious as to the global epidemic that we’re currently in, of youth mental health challenges, and how that has impacted your work.

Yeah, it’s, I mean, it definitely impacts it in a very real and practical way. Because I see it in my clinical practice, you know, and I see that in our son, he’s 23, I see his worldview, and that of people that he knows and just how shaped their their lives are, by fears around climate change around closed off possibilities, you know, that, that my generation, quite frankly, have access to in terms of homeownership and college without debt. And, and then also, you mentioned social media, social media is really a blessing and a curse. And I mean, people tend to focus on one or the other, either how much it helps or how much it hurts. And I think it’s important to look at both because they’re, they’re definitely instances of toxicity with social media. And there are instances where it’s helped people heal by connecting them with the community. And, you know, they don’t feel alone they are empowered with information. So I kind of may have strayed a little from your initial question, but just to answer it It’s on the minds of so many people in this field, you know, the state of young people and the world, the state of the world that that awaits them, not only awaits them that they’re in now, but also that is affecting feelings of hopelessness. And of course, you know, I mentioned all these things, I didn’t mention the pandemic, you know, when that’s a huge factor, but you know, the, that young people’s lives for a significant proportion of their existence were really affected.

So in your private practice, then do you see any other trends? Have you seen any other common trends among your patients? As to the root causes of some of these suicidal thoughts?

I don’t know that this is specific to my private practice. I mean, I’ve definitely observed it there. But also, in general, I think there’s a growing awareness that suicide isn’t only a mental health issue. You know, it used to be thought that 90 to 95% of people who died by suicide had a mental illness. And now research is showing that that number is probably significantly lower. And of course, mental illness vastly increases the risk for suicide. So I’m not, I’m not implying that they’re not related. But there are also things that have to do with quality of life that are related to suicide, and that can be homelessness and employment, debt. Social isolation is a big correlate, and relationship problems, but there was something else I was gonna say. There was something else but it fell out of my head. But you know, that there’s an awareness that, that it’s not only mental illness, it can also be societal conditions. And even, you know, this is kind of a buzzword these days, and but social justice, you know, that suicide is a social justice issue. And I was really struck during the first months of the pandemic, the suicide rate actually went down in the United States. And in fact, I believe it was that April of the, when the pandemic began that went down markedly like almost 10%. And, of course, we don’t know why for sure, but but some of the things that I hypothesize, that are related to that decrease are that in the United States, student loan payments were suspended, unemployment was increased, there were pandemic stimulus checks, that went out to people, evictions were halted, you know. And so, and we see to that in other countries around, like, especially in some of the European countries, where there’s a social safety net suicide rates have actually been declining while they’ve been increasing. And I realize you’re in Canada, and in the United States. And so we’re in different places, and you’ve got more of a social safety net.

That is so interesting, in terms of of those statistics and how they fluctuated, you would think the exact opposite. Given some of that background. Let’s talk about how parents can spot signs, clues. If they have a child or children who may have suicidal ideation, what does that look

And look like many different things. And in fact, it can be invisible, because a lot of people hide, and there’s significant research that shows that a big proportion of adolescents and adults for that matter don’t tell people when they have suicidal thoughts, and even therapists, they don’t tell their therapists about 40%. And a study of adolescents and young adults 40% of those with suicidal thoughts had hidden them from their therapist. So, so having said that, some of the things to look out for would be obviously direct statements of I wish I weren’t alive. I wish I could go to sleep, and never wake up, you know, nobody will miss me when I’m gone, or people will miss me when I’m gone. You know, anything that that overtly alludes to death would be something I would be I would want to you know, say Hey, Tom, now what’s going on? You know, what, what is behind that statement? But then there can be indirect hints, you know, there can be jokes there can be I mean, I know in my book there I had published earlier this year, I talked about an emergency room doctor who people would say, How are you feeling today? And she’d say, nothing that an overdose of insulin can cure, you know, and an overdose of insulin is fatal. And they just laughed, because they thought she was kidding. But she wasn’t. And so, the other things I would look out for with adolescents and young adults is, are they isolating? Are they using drugs or alcohol more than usual? And I know that’s hard to know, much of the time, are they? You know, this is an age adolescents and young adults, it is an age when many, many, many mental illnesses do emerge. And so while I said suicide isn’t only due to mental illness, it definitely is a big correlate. And so, are they demonstrating symptoms of depression, sleeping much more than usual, I know adolescents sleep a lot. But you know, sleeping much more than usual, or not able to sleep much at all southern apathy about grades or sports or other things that have interested them in the past. Low Energy, sadness, feelings of guilt, you know, those are symptoms of depression. So So those are some of the things that I think would be important to look out for, we know that a breakup of a romantic relationship can be a period of heightened risk. Having a friend attempt suicide or die by suicide can create additional risk. And so I think it’s really important, and I suspect you’re gonna ask me about this, but I’m gonna go ahead and just volunteer. And I think it’s important to really directly ask the question, if if you’re concerned, as a parent to ask your child, you know, a lot of teens today that they’re having suicidal thoughts, do you have suicidal thoughts, you know, just as a way to open the conversation, and show that the parent isn’t afraid to talk about it, the parent won’t flip out, you know, the parent wants to know, for those reasons, I think asking directly is important.

So much of what you’ve just described, there really, is rooted in communication within the family communication with your child, that obviously does not exist in every family. You’ve got all kinds of family structures as well. What would you say? Or what can you offer as a practical tip to help empower parents to actually try to have this conversation if they are concerned, as they try to sort of, you know, parse through all these different potential signs and symptoms that you’ve just outlined there?

Yeah, I think the most important thing is people have a fear that if they asked their child about suicidal thoughts, that it will trigger suicidal thoughts or give the idea. And so I want to provide the assurance right off the bat, that there’s, there are recurrent research studies that show that that is not the case. And in fact, you know, most people learn about suicide at a very young age, even if they may not know the word suicide, but most first graders know that there are people who intentionally end their own life. So by bringing it up, you’re not introducing a new idea to an adolescent that they haven’t considered, or that they wouldn’t have considered before. And in addition, the research shows that it doesn’t make people worse to ask. There’s a small percentage of people who say it is upsetting to be asked, but they get over it, like within minutes. And the risk of not asking is so much greater than the risk of asking, you know, you know, if you ask, and they get upset for 10 minutes, that’s very different than not asking, in missing really, what could be a precious opportunity to help. So that’s the first thing I would want to say. And then the second thing I would want to say is that you don’t have to be perfect. And you don’t have to ask the perfect way. I mean, that’s one of the hesitations I have in my book, and I tried to make it clear is that I was giving advice on how to ask, but it doesn’t mean there’s not a script. And it doesn’t mean that, you know, you should be so preoccupied with your words that you’re not present. The important thing is to show genuine interest, concern and curiosity and to listen in a way that facilitates the person saying more. And that’s where I mean on my website, speaking of I have a site I have a post and the title is something like In reasons adolescents don’t tell their parents about suicidal thoughts. And these were things that just kept coming up in my own practice that I was hearing from other adolescents. And, and some of the reasons are that their parents get mad, or their parents guilt them and say, like, How could you think of hurting me like that, or their parents tried to instantly cheer them up and say things like, you couldn’t possibly have real problems here. You’re too young, you know, this, this is gonna pass and, and parents who make statements like that are very well meaning and they’re usually afraid, you know, and so they’re their comments come from a place of love and fear. And I use the phrase brave listening, I hope that parents can feel that fear, but still be brave, and ask the question, are you having thoughts of suicide? Or do you think of killing yourself? Or if it’s too scary, that goes straight to that? I mean, do you ever have thoughts that you wish you were dead? Um, and then listening bravely and listening in a way that encourages the, the their child to open up rather than to shut down?
What strikes me in what you’ve just said, is so many things, but one of the things is the timing of the conversation, right? So you’ve decided that, you know, you need to have the conversation, you figured out what words to use to have it? But now the question is, when do I have it? And I wonder what your thought is on that? I mean, is there a right time? You know, you obviously don’t want to wait till it’s too late, clearly. So what kind of advice do you share on that?

Well, I would say, first off, there’s probably never a perfect time. I mean, there’s always going to be something like, Oh, we’re walking out the door, or we’re in the car, or, you know, it’s right before they’re going to bed, you know, there’s always going to be something where you think it could be a better time. But I think, ideally, if somebody makes a joke about suicide, or says something that indicates they’re experiencing feelings of helplessness about themselves or the future, ideally, you would ask right then and say, it sounds like you’re really struggling with something, you know, and again, this isn’t a script. I mean, there’s 1000 things you could say, but just I’m throwing something out there. That if your child said, like, Oh, why even bother? You know, nothing good is gonna happen to me anyway, you know, hmm. Gosh, that statement? sounded really hopeless. I mean, what’s going on? You know, can you tell me more about what you meant? And then I like the approach of normalizing. And by this, I don’t mean that we normalize suicide, but we normalize talking about suicide and asking about suicide. And we can normalize it by saying, you know, as I said earlier, that there are a lot of young people who do have suicidal thoughts, and they were conveying that they’re not a freak, if they’re having suicidal thoughts, you know, and which is probably not the best language for me to have used, but, you know, that’s how a lot of adolescents feel is that their, there’s something wrong with them. And, and then we’re conveying that it’s okay to talk about it. And even if you ask, and your child is like, no, no, God, no, or, or say they don’t want to talk about it, say they’re like, Mom. Yeah, boundaries, you know, whatever they say. It doesn’t mean that they won’t tell you later, you know, I mean, it’s important that you’re conveying that you want to know, and that there won’t be negative repercussions on your end if they are feeling that way. And the other thing I would say is if they say, No, no, no, I would never think that don’t presume they’re telling the truth. Because a lot of people say no, because they’re scared. You know, and they really do have suicidal thoughts. And they’re saying no, and so then what you say next can be really important. Because if if you were to say, Oh, thank God, I don’t know what I would do. If you ever had suicidal thoughts, and they really are having suicidal thoughts, then they might think like, Well, I’m not never going to tell them that, you know, so. So on the one hand, I’m saying there’s not a perfect script, but there are things to watch out for and to be mindful of, and one is that your child may really have suicidal thoughts. So rather than saying, Oh, good, I’m so glad you don’t. I mean, it could be that you say, Oh, that’s so good for me to know. If you ever were having suicidal thoughts in the future, do you think you would tell me and it’s surprising how many people are honest and say, No, I wouldn’t tell you. And then that’s a great opportunity to find out why. And in my own experience as a therapist, and just as a regular person in the world, what I’ve encountered is people are scared that you’ll call 911. You know, and that they’ll be taken to a hospital right away. So then that could give you the chance to say, Oh, if you are having suicidal thoughts, and you told me, I wouldn’t call 911. Right away, I would want to have a conversation with you and find out what’s happening. You know, and, and I might never call 911. If you have, you know, if you had a weapon in your hand, then yeah, I probably would, you know, but if, if we’re just having a conversation, that alone, you know, suicidal thoughts alone aren’t a reason for me to call the police. And then that could dispel fears. So calling 911 and being hospitalized tend to be people’s fierce.

Good parents even be the ones to have this conversation with a child. And when should a parent not be the person to have that conversation about suicide with their child?

I think parents definitely should, because parents are in the trenches, you know, they’re seeing their child, many, many more hours than any mental health professional can. I’m not saying mental health professional should on this too. But I’m saying that parents, they’ve got the opportunity to ask their their the availability, the the intimacy, the knowledge of their children more than anyone else will. Where I would say it’s time to involve a professional is. If, you know, almost always if someone’s having suicidal thoughts, then they’ll benefit from mental health treatment of some kind, you know, whether that’s psychotherapy, whether that’s a risk assessment, whether, in some cases, it may even be medication, not my wheelhouse. I’m not a psychiatrist, but just there’s research that shows that. So I don’t think it’s either or, you know, that either parents ask, or they don’t, they can be both that they ask, and then they connect their child with help.

We talked about this a little bit earlier, but I wanted to get more granular on social media, and in and of itself, is it safe to say that it has been an influencer, where we’re concerned suicidal ideation? And how can a parent combat or try to manage this whole piece where oftentimes, they may have no idea that it’s going on?

Right, right. And there’s so many aspects of social media to better frightening both for kids and parents, you know, I mean, there’s bullying, there’s the feelings of inadequacy people can have, by comparing themselves to other people’s idealized photos of themselves. And then there’s outright abuse that can happen, you know, where, I don’t know if you’re having this in your area, but I’ve heard of several cases where somebody pretends to be a very attractive girl and reaches out to an adolescent boy and elicit from them graph sexually graphic photos or videos and then blackmail blackmails them with it. And yes, extortion and and they’re not a pretty adolescent girl they’re 45 year old guy and you know, usually in a different country and possibly in a different country. So So there are a lot of ways that the that social media and makes things harder for parents and teens alike. And you know, there’s it’s controversial some researchers say, well, but we don’t really know that an increase the suicide risk, there is some evidence that it does. There definitely is evidence anecdotally that it does. I think the news has had many different stories of somebody who saw something on social media, they were being bullied or they were being pressured in some way and and they acted on suicidal thoughts as a result. But as I said before, there’s also good things about social media. So your question was then what can parents do and that’s what’s controversial is some people say give kids freedom don’t monitor their social media use you know, they’re almost adults show that you trust them. But I tend to come in on the more cautious side and and say, you know, not monitor them where you’re tricking them and catching them but be open. You know, like, I’m gonna put this up I don’t want this app on your phone, so that I can make sure nobody, that there’s not somebody preying on you. You know, and, and I’ll be honest with you, I did that with our son and I stopped a couple of things that could have been really, really terrible. You know, like, a 30 year old person trying to arrange to meet them at a hotel when he was 14, you know, so, so I come in more on the side of caution. And, and some parents they say to me, or they don’t really say it to me directly, because they don’t know me. But they’ll say like, oh, I can’t believe parents who do that. And in my mind, I’m thinking you’re really lucky, if you haven’t had to do that. You know, or, or you’re really lucky, if nothing’s happened, and you haven’t monitored your kids, social media use.

A pain point in many families would be getting a young person who you’ve identified as potentially needing professional help, to actually agree to go get it with them without them whatever that looks like. How can you help support as a parent, a child to go and get that professional help?

Yeah, that’s a really good question. I recommend if if you have the resources to do so. And I have to say, I don’t know how the system works in Canada, in terms of your nationalized health care, but if parents have the resources to take their child to more than one provider, so that then the child can say, I like this one, not that one, and they can feel empowered in the process, then I recommend that in really just generally as being as empowering as possible, you know, and giving them choices. Where you can like, do you want to go in the evening? Or do you want to go immediately after school? You know? And what, what kind of person would you feel comfortable talking to a man or woman or somebody who’s gender nonconforming? You know, it, just really getting their information and taking their preferences into account. But it is hard if they’re completely opposed. You know, it can become a power struggle, and very few people in power struggles against, you know, with their children.

Against the backdrop of presumably a clock ticking. Yeah, potentially. Right.

Yeah. So and that’s something else too, is like, you know, is there someone you’d feel more comfortable talking to besides me? You know, it doesn’t, you know, I may be your mother and and want to know, but if there’s someone that you’d feel more comfortable talking to about getting help, you know, I don’t mean just a professional. But would you rather talk to your aunt, your grandmother, your uncle, you know, just really trying to involve them in the process as much as possible.

Dr. Freedenthal, I have to tell you, I found your work fascinating. And it reminded me of myself as a young reporter in the late 90s, early 2000s. And when we were out of story, or covering a story, where everyone knew it was a suicide, we were not allowed to report the word suicide anywhere in our script for years. And so here we are talking about this very openly. And one of the reasons that we weren’t allowed to do that is the copycat mentality that people were afraid of not that long ago, were talking about 20 years ago. Where do you stand on that? Because now we hear about suicides on a fairly regular daily, in some cases basis? Does this give ideas to young people, adults, whomever, the more that they hear about it?

That’s a great question. I mean, there’s a paradox because on the one hand, we know that asking somebody if they have suicidal thoughts doesn’t do damage. But we also know that when somebody dies by suicide, it increases risk for the people in their sphere. So if a celebrity dies by suicide, there have been documented cases of suicide rates increasing after a celebrity suicide. Not every celebrities, but you know, there there has there have been enough that we believe and when I say we, I mean like the suicide research community believes and knows that there can be a sort of contagion effects. And we see this like in, in, in the United States, Native American reservations, I think they’re called reserves in Canada. There can be a community that has a highly disproportionate number of suicides, you know, because one triggers another triggers another triggers another. And we see it in high schools, we, you know, there there can be they’re called clusters. And so both are true that it’s okay to use the language and that suicide itself can give people the idea. I mean, one way I’ve heard it described is that, you know, an adolescent has said, several adolescents have said that, to me, that when a friend died by suicide, it made it seem more possible to them. You know, that here was this abstract concept. And now it was real to them, which to me makes it all the more important to ask and to talk about it. There is some research that shows that stories that are published that are inspirational, like not necessarily, you know, contrived, inspirational, but that do report about treatments that do report that people can get better. You know, that most people with suicidal thoughts, the vast majority do not die by suicide, that those can actually have a positive contagion effect, you know, that they can help people who are in that state of mind themselves.

What do you say to people and parents, among them? Who strongly believe that on some level, suicide is ultimately an act of cowardice by the person taking their own lives? What’s your reaction to that?

Oh, so hard, because there’s so many negative judgments about suicide along those lines. And one thing I would say is, parents who voice opinions like that they need to be mindful of well, now if their child has suicidal thoughts, will they feel safe telling their parents, you know, oh, my dad will just think I’m a coward. You know, so that’s something to just be mindful of. The other is I personally view based on my own professional and personal experiences, I view suicidal thoughts and suicide itself to be something that happens to a person, you know, someone in a rational state of mind may judge the person’s actions based on that rationality, but somebody who’s in a suicidal state of mind, is coming from a completely different perspective. And it may be circumstances beyond their control, that are pushing them to die by suicide. And so they’re I think, judgments like selfish, cowardly, sinful, things like that. Those don’t help and they inhibit people from asking for help. So my advice tends to be even if you think that is it helpful to say that, you know.

You met your husband at a conference about Suicidology? I’m curious as to the fact that both of you are in a similar line of work, which is not, shall we say, Orthodox line of work? How does that impact your son?

Oh, that’s a great question. Um, yeah, that’s a really good question. In fact, our son did have suicidal thoughts for quite some time. And He permits me to share that. So I’m not revealing a competence to, you know, 1000s of people. And that possibility was raised, like, Could this be a way since you both are involved in suicide prevention? Could this be a way of him trying to get your attention, so to speak? And that’s possible, but there’s also many other ways to get attention. You know, so if anything, I hope, you know, looking back, I hope it made it that he could talk to us more easily about his suicidal thoughts, you know, because we weren’t quite privy, you know, and, obviously, I don’t know where they don’t know, but I do know that I knew a lot. You know, and so we took him for help. We, we did various things to keep the environment safe at home. We asked him, you know, how are you feeling? How are your suicidal thoughts? You know, what are your What are your suicidal thoughts telling you? So I hope that there was a positive effect, but I also recognize that it could go the other way.

We’re almost out of time, but I did want to end on a positive note on a very unsettling topic to many people. You contend that studying suicide gives you hope. How is us?

Well, for one thing, before I became involved in suicide prevention, I thought that having suicidal thoughts no If there was a really big chance he would die by suicide. And now I’ve learned that I figured out the math once I think it’s 99.7% of people who have serious suicidal thoughts do not die by suicide. So I find it helpful that that even though these suicidal ideation, the clinical term for suicidal thoughts can be so compelling for people that most people survive them now I’m I agreed that it’s not 100% of people, you know, don’t act on suicidal thoughts, because that three tenths of a percent is a huge tragedy. But it also gives me hope that most people who attempt suicide and survive, don’t go on to die by suicide. It gives me hope that we have found various ways to help people who have suicidal thoughts. There’s a number of psycho therapies that have demonstrated at least some effectiveness in helping people and these can include like cognitive therapy for suicide prevention, dialectical behavior therapy, the collaborative assessment and management of suicidality, which is cams. There’s even a couple of medications that that appear we’re not sure but that appear to have a direct causal link to lowering suicide.

Dr. Freedenthal, suicidologist, psychotherapist, we thank you so much for your time and your expertise today.

Thank you.

Dr. Freedenthal spoke to Lianne Castelino, host of Where Parents Talk, from Denver, Colorado. In the video and podcast interview, she describes various trends that can influence teenage suicide rates. “There’s a growing awareness that suicide isn’t only a mental health issue. It used to be thought that 90-95% of people who died by suicide had a mental illness. And now research is showing that that number is probably significantly lower.”

Suicide is driven by factors that include homelessness, debt, unemployment, and social isolation. Where a social safety net exists, often suicide rates decline because people feel cared for. Freedenthal hypothesizes that this may be why U.S. suicide rates dropped nearly 10% at the start of the pandemic, since evictions and loan payments were suspended and stimulus checks increased.

Social media can fuel negative emotions that stem from feelings of inadequacy through comparison, cyberbullying, and even blatant abuse, such as extortion. When it comes to managing social media, Freedenthal recommends that parents take a cautious approach. She says to monitor what kids do online, while being open about it with them.

Freedenthal urges parents to practice what she calls “brave listening”—asking tough questions and then listening in a way that encourages a child to divulge their feelings. Respond carefully, so as to keep the lines of communication open for further discussion. “It’s important that you’re conveying that you want to know, and that there won’t be negative repercussions on your end if they are feeling that way.

dark hole with a light at the end

While studying suicide sounds intense, Freedenthal maintains it gives her hope. “99.7% of people who have serious suicidal thoughts do not die by suicide,” she says. What remains positive is that “we have found various ways to help people.”

During her interview with Where Parents Talk, Freedenthal also discusses:

  • What clues or signs should parents look for?
  • How can a parent tell when professional help is needed?
  • Is there an ideal time to have a conversation about suicide with a child?
  • Does talking about it increase risk of suicide?

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