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Eye on Psi Chi: Winter 2018
 

How to Talk About Suicide
With Paul Quinnett, PhD

Meg Sutter, University of Tennessee at Chattanooga
https://doi.org/10.24839/2164-9812.Eye22.2.40
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Today, stories of mental illness and health are abundant in the media. A Netflix series features a high school student’s suicide, comedians and actors are speaking out about their own experiences with depression and anxiety, and TED talks and podcasts focus on psychology. Why, then, is suicide still a taboo subject?

Dr. Paul Quinnett is a suicidologist and founder of the suicide prevention program, QPR, which stands for Question, Persuade, Refer. The program teaches people how to recognize the warning signs of suicidal thoughts and behavior, and how to help. According to him, we have come a long way in the suicide prevention movement, but we are still struggling with harmful language, media portrayal, and intervention. Although we want to help, we are fearful of hurting others and embarrassing ourselves. Perhaps one reason we aren’t talking about suicide is because we don’t believe we know how. In today’s interview, Dr. Quinnett explains where some of the stigmas about suicide come from, as well as ways to overcome these stigmas through language and intervention.

Stigmas Perpetuated by History and Language
Historically, suicide has been seen as a crime. In the fifth century, St. Augustine even declared it a sin, although Dr. Quinnett emphasizes, “It wasn’t a sin until then. In the Old and New Testament, suicide is not called a sin.” After St. Augustine, suicide became a highly punishable act in church and under the law. People who had taken their own lives were buried in nonsacred ground, away from their families and outside of churchyards. They were isolated like criminals if they died, but if they lived, their punishment was death by execution in some countries.

“There was a terrible amount of horror and stigma attached to suicide,” Dr. Quinnett says, “and victims were punished after their deaths. Sometimes they were buried under crossroads so they wouldn’t be able to sleep comfortably in the afterlife, because cart traffic would keep them awake. There were many clever punishments for people who took their own lives. The Irish didn’t decriminalize suicidal behavior until 1993. Ninety-three!” Criminalizing people who consider suicide is not limited to the past, even though the suicide prevention movement has progressed. When Dr. Quinnett first became a psychologist in the 1970s, his first suicidal patient was directed by court order to see him, otherwise the patient would have been put in jail.

Due to our not-so-distant history of stigmatizing people considering suicide, Dr. Quinnett says, “We still have this huge amount of cultural baggage. For example, the press continues to use the word ‘committed’ suicide, which creates a negative connotation that the person acted in a felonious state of mind, as opposed to an act of desperation due to unbearable psychological pain.” Instead of feeling supported and heard, these people are criminalized. This sort of harmful language can encourage old stigmas that end up shaming people who are suffering or who have suffered from suicidal thoughts and behavior. Instead, he suggests saying, “died by suicide.”

Likewise, Dr. Quinnett adds, “The phrase, ‘failed suicide attempt’ sounds like the person failed something, got an ‘F’ on it. A ‘nonfatal suicide attempt’ would be a more proper choice of terms.” Language has the power to hurt not only those suffering from suicidal thoughts, but those who have suffered the loss of someone they love by suicide.

The Danger of Glorifying Suicide in the Media
Another language issue to avoid involves glorifying suicide, which is basically the opposite of criminalizing suicide. For example, the controversial Netflix series, 13 Reasons Why, features a high school girl who dies by suicide and leaves tapes for classmates to receive after her death. Some have said that the film’s message serves to glorify the student’s suicide, that the tapes she leaves are an act of revenge. Although Dr. Quinnett did not want to comment on the show in particular, he encourages raising awareness with the help of the American Association of Suicidology’s (2017a) recommendations for reporting and speaking about suicide. Journalists and film producers alike are encouraged to follow these guidelines in order to raise awareness without glorifying suicide. The guide is also helpful for anyone looking to better understand how to talk about suicide and what to look out for in the media.

Dr. Quinnett says, “Suicide is a really difficult subject to deal with. Sometimes, the media appears to show suicide as a solution to life’s problems.” Glorifying suicide may occur by saying all of the person’s problems were solved by death, saying that it was the only option the person had left, or specifying the specific means used to end the person’s life. This is particularly harmful to people who are already vulnerable. In the past, explicit coverage of suicide and incorrect language in the media has been followed nationally by an increase in deaths by suicide, according to Dr. Quinnett, because “we learn from imitative behavior.”

“The survivors who lose a loved one to suicide go through a lot of trauma, fear, and guilt; they wonder if there was something they could have done and how it could have happened. They can develop secondary depression, and many of them will have suicidal thoughts themselves. If somebody close to you dies, especially from suicide, you’re going to have a hard time not thinking about it. In fact, I’d say it’s impossible not to think about. This doesn’t mean that you would want to end your own life, but if you’re vulnerable and unable to cope with what’s coming at you, then you might begin to think, ‘If it was a solution for them, maybe it’s a solution for me.’” The same can be applied to vulnerable people seeing the glamorization of suicide in the media.

Sharing Stories to Promote Hope
Although it seems easy to resurrect historical punishment through the use of harmful language and criminalization, this does not mean people should be afraid to talk about suicide, especially with those who may be at risk. Dr. Quinnett says, “We can’t solve problems we can’t talk about, and if you don’t know there’s a problem, you can’t fix it. We have to raise awareness of the scope and the burden of suffering of suicide, both in our communities, our states and countries, and around the world. Most people have almost no idea how much suicidal behavior is going on out there on any given day. So the awareness needs to be there.”

The media is a powerful source of information and potential change, which needs to be conscious of its language and shed light on the first-hand stories of survivors. Dr. Quinnett believes that one of the most significant changes he has seen since he got into the field of suicidology is that “the voices of those with what we call lived experiences—those who’ve had suicidal thoughts for a period of time and those who attempted suicide and did not die—are being heard.”

Dr. Quinnett developed and funds the “Lived Experience Writing Contest” through the American Association of Suicidology, in the hopes that the stories of survivors of suicidal actions and behavior will share their stories. “Over a million people a year in America plan to kill themselves,” he says. “That’s serious thinking about suicide, but you never hear their stories, because the stigma and taboo of telling them has been so great.” The winning stories are shared to offer an example of hope and healing for survivors of suicide attempts and loss survivors, and to encourage conversations for suicide awareness and prevention.

The American Association of Suicidology (2017b) works to promote better depictions of suicide in the media, as evidenced in a recent press release made about The Show, a film that portrays deaths by suicide on-camera:

While over 44,000 people die from suicide in the U.S. every year, over 1,000,000 more attempt suicide and go on to live productive lives that do not end in suicide. Media professionals and journalists tend to focus on the sensational aspects of suicide deaths, but a larger positive social benefit is possible by focusing instead on the very real stories of hope, healing, and recovery that we know are possible (para. 5).

Stories from survivors who have lost loved ones to suicide and stories from survivors of nonfatal suicide attempts and suicidal thoughts should have the freedom and support to share. Their stories benefit not only those with similar experiences, but progress in suicide research, prevention, and reversing stigmas. Dr. Quinnett believes, “The beauty of depression deepens one’s compassion and perspective on others, and often leads to a more creative way of thinking. There’s positive psychology to be found in surviving difficult trials in life.”

Myths About Suicide
The biggest myth about suicide, according to Dr. Quinnett, is that talking about suicide will cause people to do it. “This is a protective myth to help us avoid and continue to stigmatize people who are considering suicide,” he says. “ Believing if we don’t talk about it, it will go away, while just the opposite is true.”

The second greatest myth, Dr. Quinnett says, it that suicide cannot be prevented. “Again, believing this myth means I don’t have to do anything. It releases any burden to help a fellow human being. If you believe this myth, that once people talk about killing themselves, they’re going to do it, then you don’t have to do anything. You have no obligation as a fellow traveler on this planet to look out for your brothers and sisters, and to me, that’s highly destructive to the whole social fabric of what it means to be a human being. We’re cooperative, trusting people, and we have to be able to endure and share the pain that other people are experiencing.”

Ways to Help
So you know what language to use when you talk about suicide, such as saying someone “died by suicide” or “ended their own life,” instead of saying the person “committed suicide” or labeling a suicide attempt as successful or unsuccessful. And you know how to recognize a harmful portrayal of suicide in the media, like when stories use dramatic headlines or images, cover the event repeatedly, or glamorize the death, (American Association of Suicidology, 2017a). But how can you, personally, recognize and help someone who is considering suicide?

“First of all,” Dr. Quinnett says, “you have to be alert to the possibility that suicide could occur to somebody you already know, and that means that some situational awareness is necessary to the possibility that people could die by suicide. You shouldn’t believe myth number one, that you can’t stop them, so why try?” While developing QPR, which he describes as a kind of CPR for suicide prevention, Dr. Quinnett used his background in army intelligence to emphasize the importance of recognizing and responding to anything dangerous: “Surveillance is key.”

The second step is directly asking the person what’s going on, if anything is wrong, and if suicide is something the person is considering. “Then learn to be a good psychologist and shut up and listen,” Dr. Quinnett says with a laugh. “Step back and let the person start talking and use your active listening skills. It is important that you listen and sit on your own anxiety so that it doesn’t interfere with what the person is telling you.”

After confirming the person is in fact thinking about suicide and listening, Dr. Quinnett says, “People start to feel a little better, and you can help them with that next step, which is referring them to a place where they can get some help—the college counseling department, for example.” So according to the steps in QPR, you question how they are and whether or not they are thinking about suicide, persuade them to talk, and refer them to a helpful resource.

Whether or not from QPR, Dr. Quinnett hopes suicide prevention training will become universal. “In fact,” he says, “lots of people have said QPR should be a universal intervention for anyone in distress, whether or not they’re thinking about suicide, because you’re really teaching compassion, you know, leaning into someone else’s suffering and seeing if you can help.” Suicide is a preventable form of death, and Dr. Quinnett believes in a positive outcome. “Suicide prevention is an enormously rewarding work, because you get to do something that few people get to do in this world, and that’s actually saving a life,” he says. “This is an existential engagement with someone who’s trying to answer Shakespeare’s question, ‘To be or not to be?’ What could be more fascinating, challenging, and interesting than that as a psychologist?”

Reader, whether or not you see suicidology as a future profession, everyone can take the steps necessary to recognize a potential suicide crisis and intervene. We can change the way we talk about suicide, how we encourage survivors, how we destigmatize what history has taught us, how we portray suicide in the media, and how we choose to step in on behalf of our fellow human beings. Start conversations with the right language, listen to stories from survivors, and be alert to harmful portrayals in the media. Take responsibility without fear, because there are resources, guidelines, training, and so much hope. Suicide is a preventable kind of death.


References
American Association of Suicidology. (2017a). Recommendations for reporting on suicide [Resources and Guide]. Retrieved from http://www.suicidology.org/Resources/Recommendations-for-Reporting-on-Suicide
American Association of Suicidology. (2017b). Suicide prevention field prepares for release of ‘The Show’ in midst of National Suicide Prevention Week [Press Release]. Retrieved from http://www.suicidology.org/Portals/14/docs/Press%20Release/The%20Show%20Final.pdf


TEST YOUR KNOWLEDGE
Here’s a short interactive game maze learning tutorial Dr. Quinnett and his team developed to help change the language of suicide:
http://courses.qprinstitute.com/maze/quiz?i=599ae150620a2b568157dac1.

The QPR Institute is applying e-learning technology to suicide prevention education and training, thus enabling clinicians and others to learn and practice evidenced-based interventions to test their skills in working with people at risk of suicide.

Paul Quinnett, PhD, is currently the President and CEO of the QPR Institute, an educational organization dedicated to preventing suicide through “excellence in education.” Author of eight books and an award-winning journalist, he is also a clinical assistant professor in the Department of Psychiatry and Behavioral Science at the University of Washington School of Medicine in Seattle, Washington. In addition to directing a large, public sector mental health program for adults and elders for 30 years, and serving as director of an American Psychological Association-approved internship in clinical psychology, he maintained a private practice in psychotherapy, law enforcement, and corporate consulting. In the early 1960’s Dr. Quinnett served in the US Army Security Agency in Asia (now NSA). Much of his work in suicide prevention is based on his military training in surveillance, signal detection, intelligence gathering, threat assessment, and analysis of human behavior.

 

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Copyright 2018 (Vol. 22, Iss. 2) Psi Chi, the International Honor Society in Psychology


 
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Eye on Psi Chi is a magazine designed to keep members and alumni up-to-date with all the latest information about Psi Chi’s programs, awards, and chapter activities. It features informative articles about careers, graduate school admission, chapter ideas, personal development, the various fields of psychology, and important issues related to our discipline.

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