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depression is that it is a debilitating and potentially deadly medical
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other reality of depression is that there is hope.
Down & Up Show #57: Depression and Suicide
DR. REEF KARIM:
Welcome to the show on DepressionisReal.org. I'm your host, Dr. Reef Karim,
psychiatrist, addiction specialist and relationship therapist.
Today we'll be speaking with Charles Gross from the Weill-Cornell
Medical College of Cornell University.
He will discuss his study, very interesting topic, suicide tourism
in Manhattan, New York City, which discussed the high prevalence in suicide
committed in Manhattan by tourists.
Welcome, Charles, to our show.
DR. CHARLES GROSS
Thanks very much.
DR. REEF KARIM
So this is an interesting topic. What made you decide to research
the topic of suicide tourism?
DR. CHARLES GROSS
Well, the data itself spring from a larger sort of epidemiologic
study of unnatural death in New York City that has been ongoing since
1990.
And suicide is just one part of that. And then in looking at the
numbers and collecting the data at the medical examiner's office, it jumped
out that there were a number of, you know, a fairly high number of suicides
that occurred in Manhattan of people that didn't live in Manhattan.
So that was sort of seen in light of two things. One is that a
lot of literature and suicidology is about access to lethal means.
And one of the co-investigators in our study has previously published
a piece about how the means, the methods that people generally use for
suicide are the ones that are most readily available to them.
So it seemed interesting that there was a fairly large percentage
of people that were seeking out means that were not in their immediate
environment, at their immediate disposal.
So then we looked at the numbers in order to, you know, sort of
dissect it quantitatively, look at the demographics.
DR. REEF KARIM
So the concept of suicide tourism is going out of town accompanied
by suicide.
DR. CHARLES GROSS
Right.
DR. REEF KARIM
And utilizing sometimes well know places or bridges or whatever,
whatever there is in that place that you went to try to commit suicide.
DR. CHARLES GROSS
Right. I mean, the one thing I would say is that we're not necessarily
implying that somebody traveled in order to commit suicide.
It's also possible that someone ...
DR. REEF KARIM
Yeah, because that's ...
DR. CHARLES GROSS
... may be in the place, you know, and they experience some sort of episode,
depressive, manic, psychotic, whatever, that may happen in the moment
due to any number of circumstances as well.
DR. REEF KARIM
Is it the stress of traveling without having the structure that
you have at home in regards to psychiatric illness that's not there or
is it something about the place?
DR. CHARLES GROSS
Well, I think, yeah, I think it could be either of those things,
and I think that really depends on the individual.
There is some literature about people so decompensating when they're away
from home, and that may make them more vulnerable.
And that, in combination with the lethal means that are available,
especially in a place like New York with high buildings and what not,
that could be a particularly lethal combination.
There are also a number of sites where people plan their suicides,
you know, very far in advance and are very deliberate and specific about
the place that they seek out.
Notably there's been a lot of, you know, a lot of work and attention given
to the Golden Gate bridge. That really draws people to it specifically
for that purpose.
So I think it could go both ways.
DR. REEF KARIM
Can you talk a little bit about the study's methodology?
DR. CHARLES GROSS
In terms of the data collection?
DR. REEF KARIM
Yeah.
DR. CHARLES GROSS
Well, like I said, it's part of a very large long-standing study that,
where we collect data from the New York City medical examiner's office
to look at any death that's not natural.
It could be homicide, suicide, accidental. We look at ethnicity,
age, neighborhood, gender, toxicology, and then look at the manner and
cause of death.
And that all kind of gets thrown in to a pot where we can analyze
that data and look at a number of trends, from any number of perspectives
and with different research issues in mind.
DR. REEF KARIM
So in this study there were 274 of the 407 non-resident suicides
in New York committed in Manhattan.
DR. CHARLES GROSS
Right.
DR. REEF KARIM
Which represents over 10% of all suicides committed in Manhattan.
DR. CHARLES GROSS
Right.
DR. REEF KARIM
So can you tell us a little bit about why this statistic is so
high? Why were there so many non-resident suicides there, and what she
would take from that finding?
DR. CHARLES GROSS
Well, I think that, you know, like I said, I mean, this is a, this
was a quantitative study, mainly to show that the phenomenon exists.
So I can't, you know, both for confidentiality reasons and just because
I don't know the answer, I can't say exactly why the number is so high.
I would say that, you know, there are places that are, for whatever
reason, attractive to suicidal individuals, and the concentration of suicides
both around, in Midtown and at the George Washington bridge indicated
that those were places where people came to.
The other issue is that there are, sites and places can have symbolic
meaning to an individual.
You know, there can be a political protest, there can be maybe
a desire to be seen, there can be a desire to be more anonymous.
Those are all possibilities for why people are attracted to Manhattan
for suicide.
DR. REEF KARIM
So you mentioned New York offers heights and many people who were
maybe overwhelmed, vulnerable, fragile, were maybe over stimulated and
maybe couldn't handle it.
And so because New York offers heights that's one direction that they
thought of in regards to suicide when they were thinking that.
DR. CHARLES GROSS
Sure, or they actually thought it out. You know, someone may have
gone there for that reason, because they heard about it being an effective
way, because they want, there's some meaning to seeking it out for them.
Or just because of it's lethality.
DR. REEF KARIM
What were some of the other findings in the study?
DR. CHARLES GROSS
About the, about the demographics?
DR. REEF KARIM
Yeah, I mean, what else did you assess in the study in regards
to instrument, in regards to other data that you collected?
DR. CHARLES GROSS
Well, you don't mean the overall study, you mean more like this specific
suicide study?
DR. REEF KARIM
Yes.
DR. CHARLES GROSS
Well, we looked at the demographics and we found that it's a younger type
of individual compared to the residential suicide.
We found that the individuals are more often White or Asian and
less often Hispanic or African American.
We found, like I said, that the means were very often long fall.
Interestingly, and that was, you know, either from a bridge, so
a drowning would be included in that either from a bridge or from a hotel.
Interestingly there are also a number of people that hang themselves
in hotel rooms in New York, which that brings up sort of another question
because that's something that someone could do anywhere theoretically.
So, you know, the question is why, why New York, what brought this
individual to this point at this place to take their life in that way.
That would not be a case of just access to a lethal method.
DR. REEF KARIM
And in your opinion, what are some tactics that can be put into
place to help prevent this rising trend?
How do you strategize against that? What can we do as professionals
to assist helping people get the help they need instead of the suicide
tourism?
DR. CHARLES GROSS
Well, I think that there's a couple of issues involved in this.
I mean, at the most basic level would be, from a sort of public
health perspective, I think prevention efforts aimed at sites that are
frequented, you know, for suicide.
Barriers and phones and things like that. I think that, you know,
the other issue is sort of finding new ways to reach people.
Like understanding whether this is a specific kind of an individual
with different warning signs that needs to be assessed and reached out
to in different ways.
I think, you know, lots of new media. I mean, there is cyber suicide,
you know, suicide that's influenced by the internet.
Chat rooms, people discuss different methods of suicide, you know,
over the internet.
00I think that prevent efforts need to catch up to those things
in terms of the way that, you know, getting the word out in terms of reaching
people and prevention and, you know, different types of campaigns to reach
individuals.
As well as just bringing awareness in places like, that are maybe
high profile areas where suicides are known to occur, just increasing
public awareness to people in need.
DR. REEF KARIM
Do you think the media plays into this as far as New York being,
having a lot of media around it.
Say L.A. has a lot of media around it, movies, you know, things,
violence, history, things like that. Do you think that plays into this
at all?
DR. CHARLES GROSS
Yeah, I really think it does and that's a real specific interest of mine.
I think that certain places can take on a certain drama and a certain
sort of symbolic appeal to people because of the way that the reputation
of the place or the grandeur of the place, the drama of the place. And
like I said, I think the way that the word gets spread is often through
the media.
I mean, like, you know, we mentioned in the study that there was,
there were I think three suicides in a two year period from the same place
in the same hotel in Times Square.
There is, you know, in a tabloid story in the New York Post about
it, you know, mentioned that the person wrote in their note that they
were on an out of state mission from God.
I mean, I do think people can use the media. The media, the sensationalism
of stories like this in the media can be dangerous to vulnerable individuals.
Definitely. Is that what you mean?
DR. REEF KARIM
Any closing thoughts you might want to add?
DR. CHARLES GROSS
No. I mean, the one thing that I would say is that I just got,
I was watching an interview with a guy named Eric Steele who, he directed
the movie called The Bridge about suicide on the Golden Gate bridge.
And in it, he mentioned that to some extent a person that decides
to take their life in public, that there's a desire to be seen in some
way.
And that if there's a desire to be seen, there's also a desire to be saved.
And, you know, he did interview also people that were survivors.
And once they jumped, they really wanted to live. So I think that
when you're looking at people who are trying to take their life in such
a public forum, you're looking at somebody that, you know, to some extent,
is looking for a real lethal means to kill themselves.
But maybe another level is really looking to be seen and rescued,
and so public awareness to it. You know, to be crucial with these types
of people.
DR. REEF KARIM
Well that's great. This has been a great interview.
DR. CHARLES GROSS
Oh, thank you so much, it was great talking to you.
DR. REEF KARIM
Thank you for your time, Charles.
DR. CHARLES GROSS
Okay, Dr. Karim.
DR. REEF KARIM
Thank you. For the Depression Is Real Coalition, I'm Reef Karim. Join
us next time for another segment of the Down & Up show on DepressionIsReal.org.
DR. REEF KARIM
Now we'll talk with John Draper, PhD, Director of the National Suicide
Prevention Lifeline. Dr. Draper has extensive experience in suicide prevention
and crisis center management. He previously was clinical director for
a mobile crisis service and consultant to New York City's Department of
Mental Health and as a counselor and psychologist Dr. Draper has worked
with hundreds of persons at risk for suicide. Well Dr. Draper, welcome
to the Down and Up Show.
JOHN DRAPER
I'm glad to be here.
DR. REEF KARIM
Well, we just spoke to Charles Gross of Well Cornell Medical College.
He led the study Suicide Tourism in Manhattan. It was published in the "Journal
of Urban Health". What was your reaction to the study, and in our opinion
what can we learn from this study?
It's an interesting article. But I'm not sure it's a real significant
phenomenon related to suicide. Specifically just about all of the research
shows that people aren't really traveling great distances to go kill themselves.
What's really happening is people are looking for the closest, easiest
way and perhaps most lethal way to kill themselves. They're looking for
what we call readily accessible means. Even this research shows that most
of the people who jump from buildings in Manhattan nine out of ten are
from the New York City area.
In fact of that 10% that jump who are out of the five Burroughs
area which is what they describe as non-residence about 8% of Manhattan's
daily workforce come from or commute in from areas outside of the five
Burroughs. So it's possible that a good percentage of that 10% are people
who are regularly coming to Manhattan.
So I'm not sure if that's really the kind of focus in terms of suicide
prevention that we want to spend a lot of time with. I think from the
perspective of most of us involved in suicide prevention what we really
want to do is if there are any hot spots, any specific locations where
people are killing themselves that we need to restrict access.
Perhaps put barriers like they did up on the Empire State Building
to prevent people from killing themselves by jumping off the Empire State
Building or putting barriers up on bridges. But otherwise we want to do
what's called promoting access to life saving means, and that's just making
it easier for people to find and get help such as promoting hotlines and
getting them closer and in to treatment facilities as quickly as possible.
DR. REEF KARIM
What are some of the warning signs of suicide?
JOHN DRAPER
Well, there's quite a number of them. Really one of the things that's
particularly important to remember is that a lot of people who are suicidal
are depressed. In fact about 60% of the people who kill themselves, about
two out of every three, are depressed.
That accounts for about 21,000 suicides a year. That's more than the total
number of people who die by homicide each year. So it's important for
a lot of the signs of depression such as feelings of worthlessness, feelings
of helplessness, feelings of hopelessness, those kinds of things.
When people tell you that I'm feeling worthless, they're feeling like
there's nothing that they can change-do to change their bad life, there's
nothing that they can do to change their future which they believe has
nothing but bleak outcomes ahead of them, those are the kinds of things
that we want to be looking out for.
But there's other things which are really particularly unique to suicide
that may or may not have anything to do with depression. There's things
like people who are abusing or increasing their use of drugs and alcohol.
You'll see a lot of that. In fact it's a very lethal combination with
depression.
People who report feeling alone or trapped in a situation that
they can't get out of that's causing them a great deal of psychological
pain. I think another thing that's very important that people forget about
it if a person talks about killing themselves take them seriously. 70%
of people who die by suicide communicate their intent to significant others.
So you can imagine the horror that significant others feel when
people do kill themselves that are close to them and they say you know
they told me about that and I didn't take them seriously. Other signs
when people might say things like I'd be better off dead or I'm really
just making life difficult for everyone around me. Those kinds of things
are very important for people to look out for.
People who are sleepless and agitated. Often people who in a great
deal of psychological pain can't get to sleep. They'll pace, they'll be
focused on how horrible their life is and it just prevents them from being
able to relax. If you can't sleep that really affects their thinking.
People who are suicidal often have ways of thinking that are notably
negative, kind of a tunnel vision of sorts where everything in front of
them, around them appears to be utterly negative and completely impossible
for them to deal with.
I think for a lot of-a lot of men for example who are feeling suicidal
they're not as likely to talk about their feelings and their thoughts
of suicide as much. So you need to be looking out for a number of behaviors.
A lot of reckless behaviors, a lot of risky behaviors, people seeking
out lethal means, perhaps collecting guns or pills or driving fast or
driving drunk, things that clearly put them at risk that seem to be completely
indifferent to their own safety and the safety of others.
DR. REEF KARIM
What can our listeners do if they believe someone they know is
at risk for suicide?
JOHN DRAPER
Well the first thing that's really important is don't ignore any of the
warning signs, and tell yourself that you can deal with this, that you
can help them. Rather than a lot of people are afraid that if I open this
Pandora's box I'm not gonna know what to do.
Maybe I'll be responsible, or maybe if I bring it up to them it'll just
make matters worse. Maybe I'll even-if I ask them if they're suicidal
maybe that'll put the thought of suicide into their mind, and research
has shown that quite simply isn't the case. Talking....
DR. REEF KARIM
Now you're currently the Director of the National Suicide Prevention Lifeline.
Can you tell us about the organization and your work there.
JOHN DRAPER
Well the National Suicide Prevention Lifeline is a program that's funded
by the Department of Health and Human Services Substance Abuse and Mental
Health Services Administration of the United States Government. So we
get money every year as linked to health solutions here in New York City
to oversee a network which is currently about 134 independent crisis call
centers across the country.
They're linked to a series of toll free lines the most prominent of which
is 1-800-273-talk, 273-8255, and when people call that number the calls
are routed to the nearest crisis center in the network, and if they're
busy then it rolls over to the next, the next center to make sure that
all calls are answered.
Our job is to make sure that the line works, to also provide training
and evidence-based information and standards to help improve the quality
of care on the phones to all of our crisis centers and also to do a lot
of outreach to let people know about this valuable 24/7 resource.
DR. REEF KARIM
Okay. It sounds great. Do you have any closing thoughts, anything
you'd like to add?
JOHN DRAPER
I think the most important thing is for people to be aware that
suicide is preventable and that many of the things that lead people to
feeling suicidal are imminently treatable. Depression as I mentioned
before is-the cause of two out of three suicides and depression is among
the most treatable of all mental illnesses.
About 80% of people who get treatment for depression report significant
improvement. A lot of crises, as intensely painful as they can be, are
really temporary, and it's important to remember that while there's 32,000
suicides every year, there's a lot more attempts.
In fact, there's about 28 attempts for every suicide. And there's a lot
more people than that that have thoughts of suicide. So that tells you
something. That tells you that there's a lot of people in there who are
in crisis, who think about suicide, that get through it somehow.
And often they get through it by being connected with people and
connected with treatment and getting help. And it's important for people
who are feeling that way to know that they can get help. Even if they
don't feel hopeful now, reach out and give themselves a shot.
Make a call, call the hotline, talk with their doctor, talk with
a friend or a pastor or counselor. Reach out. And for those of you who
think you might know somebody who could be suicidal, don't ignore it.
DR. REEF KARIM
Yeah. Well, thank you for your time, Dr. Draper. This was great.
JOHN DRAPER
Okay.
DR. REEF KARIM
Okay. For the Depression Is Real Coalition I'm Dr. Reef Karim. Join us
next time for another segment of the Down and Up Show on Depressionisreal.org.
