Megan Kamerick interviews Dr. Ursula Whiteside, psychologist

MK: Dr. Ursula Whiteside, many of us who are left behind after a friend or family member goes through with suicide are plagued by guilt and a lot of questions. What are warning signs that someone may be considering suicide?

UW: I want to say to you, and I want to say to other people who have lost someone to suicide that sometimes there is nothing obvious going on. It’s almost impossible to see. You can’t be inside someone’s head.

That guilt, wishing you could have known then what you know now doesn’t tend to serve us well. That’s on people like myself and the public health system and the medical system to better train family members, friends, people who are struggling to support each other, to reach out.

The vast majority of signs of suicide also just mean that the person is in a really bad spot, unhappy, probably experiencing some depression and anxiety, extended periods of difficulty sleeping are things to watch out for. Extended periods of withdraw and also irritability or pushing people away and definitely talking about suicide are things that would be very important to follow up on.

Ask the person what they mean. Have them explain what’s going on with them in their life with real curiosity before trying to convince them of anything. Those are some of the most important ones.

There is a great list on the American Foundation for Suicide Prevention website, AFSP.org where you can find more information.

MK: We will put that on our website along with other resources for sure.

This idea that sometimes when people turn to suicide, there has been a surge of emotions, it’s very sudden. Talk a little bit about that.

UW: As part of our research project, we interviewed a whole group of people about their suicide attempts. In general, their lives were not going well and on the day that they attempted, for those folks that I interviewed, had not had a specific plan to harm themselves. There was usually something that happened like a fight or something that seemed like the end of a relationship or something that seemed like it was going to be impossible moving forward or at least it felt that way in the moment.

The combination of emotions being fairly high with this additional thing that has some kind of really important meaning to the person pushed them over the edge and they made an attempt when they hadn’t planned, when they hadn’t had much forethought into it and it really wasn’t anticipated.

I think there’s something really important about knowing that this is a thing that allows us to do something differently because we haven’t really been thinking that much about this suicidal experience.

We think a lot about the person who writes the letter, who finishes up their will, who takes steps in advance, but we don’t think as much about what you would do to intervene and support somebody who may be at risk of having this overwhelming urge happen.

It’s never just one thing that causes someone to attempt to take their life. Sometimes it can be a combination of a whole bunch of different factors and then one especially intense thing may put them at greater risk.

People need to be prepared for this experience. At some point, for all of us, we’ve going to have these really intense moments. Many of us will say, “Yes, I know exactly what you’re talking about where my stress level was 100 out of 100 and I just didn’t even know what to do.”

We need to prepare everybody for what to do whether or not suicidal thoughts come into our minds because at the basis of it is really, really intense emotion and how do you handle really, really intense emotion. It affects most of us in a very similar way.

MK: Dr. Whiteside, what steps can people take if they find themselves overwhelmed suddenly by these intense feelings that you describe.

UW: One of the things that we know works really well to help reset intense emotions is to use cold. The research that has been done is all about people filling a bowl or a sink with very cold water, even putting some ice in there and bending at waste while holding your breath and doing that for 30 seconds while your face is submerged under the water and then coming back up and taking a deep breath.

Doing that on repeat for three to five minutes changes the way that your vagus nerve or vagal nerve responds. There is a nerve that runs between your brain and your major organs. It innervates your organs. If you can get that nerve to change its tone, change its tautness, you can essentially change the messaging between your organs and your brain and trick your brain into thinking you’re becoming more relaxed.

MK: That is fascinating.

UW: I agree, and I use it all the time when I need to. I happen to be one of those people who has intense emotions, and it doesn’t necessarily mean I’m having suicidal thoughts if I’m using cold, it just means that I’m so overwhelmed that I can’t think clearly anymore and it’s not helping anybody at this point.

MK: Are there other things that people can do if they’re in that crisis moment?

UW: When you’re in a really emotional state, you should hold off making important decisions. We’re not seeing clearly enough to make decisions, and this is a time that people make those decisions that they can’t take back.
I got a lot of great feedback from a group of young people that I interviewed about them getting through these “hot moments,” being on fire emotionally and they said it wasn’t so helpful when people said, “You’re not always going to feel this way.” They said it was more helpful when someone would say, “Hey, we’re just going to work on getting through the next 30 minutes.”

MK: What does that look like?

UW: It does take creativity, so what I might scan through in my head is what does this person like, what calms this person down.

For some people it’s having them sit on the couch and sitting really close to them with your arms around them.
I try to get people to drink a big, cold glass of water as another way to help change their physiology or put an ice pack behind their head.

I’ll practice breathing and say, “I’m going to start breathing. I want you to breathe with me.” As I’m doing that, I’ll make my exhale a little longer than my inhale because that’s a type of breathing that can help slow somebody down a little faster than just deep breathing.

I definitely weave in humor. I might pull up a picture of a cat on the phone.

I will also say, “I’m not going to do this perfectly, so just bear with me. I’m doing my best to be with you because I love you. Just hang in here with me.”

MK: Dr. Ursula Whiteside, you helped create an organization called Now Matters Now and you are the CEO. What is the site, what is the mission behind it?

UW: This resource is intended to bring videos of people talking about how they use coping strategies called dialectical behavioral therapy skills.

There are also resources for health care providers to receive training and there is training on the website for family members and friends or for people who are struggling in something called “micro-intervention,” things that you can do in three to five minutes that can help with mood and getting through hard times.

There is a safety plan. There is a crisis line page and crisis steps like some of the crisis steps I told you about with cold and no important decisions. There is another step called “eye contact” which is explained on the website.

MK: Why is eye contact important.

UW: Eye contact is important because it is one of the strongest stimuli. When people are in an intense suicidal mindset, they are super focused on suicide. It’s almost like the rest of the room is gray or black and suicide is in bright red letters in front of them and that’s all they can see. What you’re trying to do is put something else in front of their eyes, something else to wash out some of that red in their brain. Eye contact is one of the most power stimuli that we know. It’s so powerful.

What that would mean is that if you were really struggling, you would say to someone, “Hey, I just can’t get out of my head right now. Could we talk for a little bit? Could you look at me for a little while?”

MK: Many people who attempt suicide may also be trying to manage depression or other mental health challenges. How can these accelerate or lead to suicide?

UW: One of the especially cruel things about depression is that the urges that go along with it are to withdraw and to stop reaching out and to stop making really connections.

One of the simple things that you can do if you’re depressed and you’re starting to withdraw is to force yourself to do small things. An example would be to send a text to somebody who you’re fairly certain won’t judge you, that you trust, maybe even somebody who has been depressed themselves and is open about it. At the minimum say, “I’m thinking about you” and send a picture of you guys together or something that bumps that text up a little bit in connection.

Even more effective would be to say, “Hey, this morning really sucks. I’m having trouble getting out of bed. I am committing to jumping in the shower and I’ll text you after I’ve taken a shower.” Those are a couple ways that you can fight back with depression and depression urges and fight against the isolation that it tends to create.

MK: It can be really frightening if someone confides in us that they are in crisis. What can we do if we suspect our friend or a loved one is considering suicide?

UW: I know we tend to get really anxious when someone is talking to us about it, but I think we should also be holding onto the fact that this is a really good thing. My job right now is to be present with them and see if I can understand a little bit better and see if there is something that I can do to help them get through this.

MK: That goes to a potential way to address some of this that you have explored, caring messages.

UW: Yes, caring contact was an intervention that was done many, many years ago, 30 or 40 years ago with people who were just leaving psychiatric hospitals after suicide related visits. Half of them got follow up over mail. They got a letter in the mail. These letters were done over time, not just once. They essentially just expressed care, that the letter writer was holding space for that person and that person mattered.

The way I and many others use this now is with text messaging. In the original study, people who received these caring messages, there were half as many suicides in those that didn’t get the caring messages.

MK: Wow. How can we use that technique in our own lives?

UW: I think one thing that you can do is to take 60 seconds and think about who in your life has faded out a little bit. Who haven’t you heard from that you used to hear from? Who hasn’t been on social media that used to be on? Who lost a job? Who is going through a divorce? Men especially are more likely to die by suicide and often in some ways have less connections.

Who would those three people be? Then start sending them regular messages. Like, “Hey, the game is on Saturday. I’m going to be watching it. Do you want to watch it virtually with me?” “I know this is out of the blue, but I miss you. I’m thinking of you.”

MK: Dr. Ursula Whiteside, it’s been really interesting and wonderful to talk with you.

UW: Likewise. Thank you so much for having me. I really appreciate the kind of work that you and your team does, Megan.

Megan Kamerick Interviews Bruce Shapiro, executive director of the Dart Center for Journalism and Trauma

BS: Around the world, journalists everywhere cover a huge amount of human distress and it’s not just frontline war correspondence and not just cops reporters. When there is a big police shooting, or the insurrection at the U.S. Capitol, when there are violent protests like that, these are all hands on deck moments.

Also, as young reporters, many of, including me, my first assignments involved loss, involved murder victims, involved veterans coming back from war. We cover a lot and all the research shows that journalist all over the world cover a lot of suffering. That’s number one.

Number two, and this is actually good news, we now know from research that on the whole, we as journalists are a pretty resilient tribe. Having a job to do in the face of mayhem and suffering, having craft skills, having ethical skills, having good colleagues and having a clear mission, these are all protective factors and act as a buffer against the degree of psychological injury that you might expect.

The challenge is that if we cover events which by themselves are significantly more horrifying or overwhelming or involve things like the deaths of children or are chronically threatening or resonate with other biographical traumatic experiences we may have, the mechanisms of Post-Traumatic Stress Disorder are the very mechanisms that we rely on most as news professionals so it can become singularly toxic.

We rely on the accuracy and controllability of memory. Well, folks with PTSD often deal with intrusive memories, overwhelming floods of memories that are triggered and take up attention when it’s not wanted.

Or people with psychological injury may have anxious arousal and be unable to concentrate, to focus, to be there in the moment in the way that we as reporters need. Or folks may lose their ability to make empathetic connection that we rely on that in a profound way.

That’s consequential when journalists lose their ability to function well because of Post-Traumatic Stress Disorder or because of burnout or other work-related occupational stress injuries. That’s a kind of censorship; a journalist who is no longer able to meet a deadline or get on with sources or put together a story is censored as effectively as if imprisoned.

MK: How have all these things been exacerbated by the COVID pandemic and the dangers journalists have faced in recent years from open hostility to the media?

BS: It’s so interesting, ten years ago in our work at the Dart Center for Journalism and Trauma when we were thinking about physical threats to journalists, those mostly involved the risks to frontline correspondents in war zones or in crisis areas or perhaps investigative reporters who were specifically targeted by mobsters or oligarchs. That has completely changed. When I go into newsrooms now, there are local completely apolitical police reporters and crime reporters who are subject to torrents of abuse in the comment sections of news sites or digital threat and harassment.

In journalism schools now we need to teach our young reporters how to safeguard their digital identities and to safeguard their own families from threat and abuse. It has become a legitimate part unfortunately of our political culture to attack journalists. This is adding levels of threat and stress to a profession that already deals with all the trauma exposure I was just talking about and is beleaguered by cuts to newsroom budgets, turmoil and disruption in the industry. The sense of being a profession under siege is emotionally really pretty challenging for a lot of journalists.

We get into this most of us because of a public service mission and if that mission is constantly being invalidated or is threated and we’re not being defended, that can leave us feeling more alone and isolated and can exacerbate or can become an added burden of threat.

Then you add COVID-19. COVID-19 has challenged our profession in new and very interesting ways. First of all, there are all of the ways that as journalists we are challenged exactly the way everyone else is. We’re scared for ourselves and our families. We’re more isolated. Our work lives are disrupted.

Secondly, there are some workplace pressures. We have had to reinvent how the job gets done. I’ve spent a lot of time talking via Zoom to newsrooms all over the country in the last few months and I have been so impressed with the sense of dedication and mission and energy to which people completely reinvented the process in a way that is not going to be often visible to the general public.

Then there is a third layer which is that in the pandemic, all reporters are frontline reporters. All photographers are crisis photographers. You have everyone from small, tiny, local newsrooms to big international news organizations that are covering death at an unprecedented scale that are making difficult ethical calls about how to show images of suffering, spending time around sick and dying people. People are having to figure out how to cover a detailed kind of science and health policy that was not on the radar before.

All of this means that there is a lot of imagery of distress, a lot of experience of distress that is overlaying what is already a high pressure, high stakes environment with all the political scapegoating and the need for innovation. It has been a period of enormous invisible stress on news professionals.

I think the burden is all the more significant because in this pandemic and indeed in the broader democratic crisis of American society right now, it’s really striking how journalism is actually a pathway out. A lot of people say, “Is there light at the end of the tunnel?” My view had become that actually reporting is the light to the end of the tunnel at a time when official science has been corrupted by political interest.

It is left to journalism to be the capillary system for public health understanding. At a time when government communication has been corrupted by politics, it is left to journalists not only to ask the right questions but to model a kind of engagement with these issues. The role of journalism in American society has never been more important than it is now as mediators of fact, as mediators of the social contract.

The reporters I talk to, though they don’t use that elaborate and maybe even theoretical framework are very aware of the importance of their work right now. On the one hand, this is a source of a lot of stress, a lot of worry. It’s also a source of mission and a lot of resilience and to the extent that folks in journalism can articulate that mission and share it with one another and to the extent to which the public understands that and can express appreciation for the work of news professionals right now. I think it’s a source of resilience.

If the public believes ultimately in the need of accurate information and the need for powerful storytelling and the need for journalists to speak truth to power and to bear witness for those who are at the losing end of the power equation, then the public too needs to understand just how consequential are the risks that news professionals take even at the community level to fulfill their responsibilities in our still democratic society.