Unpacking the myths of depression and suicide

Hi, I’m Jaclyn Cosgrove, mental health editor at the L.A. Times, filling in for our regular newsletter writer, Laura Newberry, who is recovering from a hand injury and will be back to answer your questions (send more, please!) next week.

This week, I wanted to take time to explore some myths around suicide and depression. My hope is that by thoughtfully unpacking a topic fraught with stigma and misunderstanding, we can all better support our friends and family who experience depression.

This is a topic that’s deeply personal to me. A vivid memory I have as a child is of my mother coming to me and explaining that my uncle, Glenn, her oldest brother, had died. I was a perceptive 9-year-old and had picked up from adults’ murmurs that Glenn was missing. I didn’t understand how or why an adult would (or could) go missing. That day, as we sat together on the couch, my mom gently explained that Glenn had killed himself. How could the uncle who bought me the greatest gift of my young life, a huge Donald Duck stuffed toy, be gone?

The following 10 years, I saw how Glenn’s death changed my family, especially my grandmother. She fell early and deeply into dementia, leading me to forever wonder if a human being in so much pain could will herself into Alzheimer’s, or if it had just happened by chance. I resented Glenn regardless.

“Suicide is the most selfish thing a person can do,” I declared throughout my teen years, loudly and ready for debate. It wasn’t until I was 20 and watched a film about suicide and prevention that I realized just how deeply my uncle was in pain. I was overwhelmed thinking of his suffering, and I was finally able to fully grieve for him.

Since then, I’ve written about suicide prevention whenever I can. When Laura asked if I could fill in this week, I wanted to explore, among other misconceptions, one of the most pervasive myths around suicide: that rates spike around the holidays. This is not true.

But before moving on, I want us all to take a deep breath. Feel your feet on the floor. How are you feeling? I know this is a hard topic, but I do promise you: I won’t get into any specifics, and I will do my best to be as thoughtful as Laura is.

The holiday myth

Let’s start with the myth.

Dan Romer, research director of the Annenberg Public Policy Center at the University of Pennsylvania, has monitored media coverage of the holiday suicide notion for the last two decades. What he’s found is troubling.

For one, the media continue to report the myth, often in stories around the “holiday blues.” (More on that in a minute.) In these stories, journalists don’t source any data or research but rather quote a mental health professional or police officer saying that the suicide rate increases around the winter holidays.

“It’s well-intentioned, but it’s just wrong, and it may not be helpful,” Romer told me. “There’s no benefit to telling people that, and it could actually be harmful because you don’t want to encourage anyone in a crisis to think other people like them are turning to suicide.”

Instead, data consistently show that the suicide rate increases in the spring, stays high in the summer and slows down in the fall, at its lowest from November to January, Romer said.

“Those three months are typically the lowest in the year, and we think it has to do with climate,” he said. “In other words, the days are shorter, they’re darker, and people for some reason we don’t fully understand are less likely to end their lives during the winter.”

One reason that the myth keeps a hold on the public is because of seasonal affective disorder, a type of depression that some experience in the fall and winter. As Romer noted, the “holiday blues” phenomenon is real, and it also doesn’t appear to result in more people killing themselves. Two things can be true at once — which is missed in a lot of media coverage.

Some have hypothesized that, during the winter months, a person with major depression looks around and sees short days and maybe even other people struggling, like with SAD. But then when the spring comes, and the sun is shining, and friends and family are out having fun, a depressed person realizes they do not feel better, and tragically they lose hope. But this also needs more research.

It’s unclear how this myth started. Romer suggested maybe one source could be the 1946 film “It’s A Wonderful Life,” where the main character considers killing himself. “But we really don’t know,” he added.

One important note: Young people, especially adolescents and young adults, appear to suffer most during the school year, Romer said.

They “show a different pattern,” Romer said. “They tend not to experience more suicides in the summer, which for them, it’s time off from school. … We don’t fully understand it — is it more bullying? Obviously there’s bullying and all kinds of stuff that goes on in schools. Is it the presence of those things? Or is it the absence of stressors? We don’t know.”

Please ask the question

Another myth around suicide ties in with the holiday myth in terms of its pervasiveness: People wrongly think if they bring up the topic of suicide, a person will be more likely kill themselves. This is also incorrect.

“Instead what we find is, if somebody is feeling down or having thoughts of suicide or death, if a loved one asks them, they actually feel heard and relieved and actually receive help,” said Dr. Madhukar Trivedi, director of the Center for Depression Research and Clinical Care at University of Texas Southwestern Medical Center.

Trivedi and other experts recommend being direct with your loved one, asking, “Are you having thoughts of suicide?”

I’ve felt grateful to be a person whom friends have trusted when they’re struggling. I’ve asked this question to multiple people. It gets easier with practice to ask, and I would definitely recommend further reading to understand how those conversations typically go. I’ve found friends who are often deeply sad and stuck with negative automatic thoughts, like “I am a failure” or “I am a burden,” which often signal serious depression. It’s important to hold space for that and also understand where it’s coming from.

Trivedi, who has researched depression for more than 25 years, said scientists are beginning to understand how a depressed person’s “default mode network” is not functioning properly.

For a non-depressed person, their default mode network allows them to sit and have random thoughts like, “I really need to have breakfast” or “That was a great movie last night.” But a depressed person can become trapped in rumination with constant negative thoughts in their brain, leading them to believe their friends or family hate them, and so on.

“Patients describe it as a dark cloud hanging over their head 24/7 that becomes so ingrained in the way they think and feel, and it stays with them for long periods of time,” said Trivedi, a psychiatry professor. “So a lot of their interactions with other people are colored by their feelings about themselves.”

This is why it can be so dangerous, or at the very least unhelpful, to try a tough-love approach with a depressed person.

Psychologist Sigrid Y. Elston said well-intentioned parents might tell their college-aged child, “You need to just get it together.”

“That’s such a strong [misconception],” Elston said. “What if you were told that? Is it that easy to just ‘get it together’?”

Instead, Elston recommends a few different approaches. If your loved one isn’t in immediate danger to themselves or others, you could ask them whether they’ve had a physical lately. More doctors are screening for depression and other mental health issues. If you know the family doctor, you could give them a heads up about your concerns over your loved ones’ depression, Elston said, although you should keep in mind that, because of health-privacy laws, the doctor won’t be able to respond.

You can also sensitively bring up seeing a therapist, while also offering support in helping a person find a therapist or driving them to the appointment if that would feel helpful to them. But if you do mention seeing a therapist, keep in mind how you might be heard. Because of the negative feedback loop in a depressed person’s mind, they might hear you don’t care, or that you’re tired of listening, Elston said.

Then they start thinking, “Why would a therapist even want to listen to me? I don’t want to burden a therapist,’’ Elston said. “That’s when it starts to get really, really dangerous.”

There are many resources available to help prepare you for any level of these conversations. Local chapters of the National Alliance on Mental Illness regularly offer classes, like Family-To-Family, where you’ll learn about supporting your loved one with mental health conditions. You can also call 988 and talk to a trained professional about how to have the conversation. Although it’s the national suicide helpline, it also serves as a resource before the crisis.

Lastly, I’d like to address a myth I once believed — that people who die by suicide are selfish.

Psychologist Julio Brionez told me this idea most likely comes from a grieving person’s pain.

“Ideally, everyone wants everyone else to live as long as they can in a healthy way, and that inability to express how much they miss them can cause a lot of pain and anxiety and hurt and rage, and not having a space to say that out loud, I think can create a mentality of, ‘I want to tell you how angry I am that you left.’ ”

Brionez added, “Generally speaking, generally everyone who wrestles with suicidal ideation or attempts suicide are strong people who are going through such severe trauma, and it can [feel] untenable to keep going.”

Suicide is preventable, and by sitting with our loved ones in their pain, we can support them in dark times and hopefully be a light.

Until next time,

Jaclyn

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

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More perspectives on today’s topic and other resources

The Be There Certificate, a self-paced mental health literacy course, was recently developed by Canadian-based charity Jack.org and Lady Gaga’s Born This Way Foundation. Designed for young people (but open to anyone who wants to learn), the free course helps the user understand how to better support those around them who are struggling. It is available in English, Spanish and French.

Mental Health First Aid is a good option for those with a bit more time to take a training course. Modeled like a CPR class for a mental health emergency, the training walks you through how to support someone through a crisis.

The suicide warning signs are often quoted in media as important factors to watch for, but as my friend and former colleague Madalyn Amato pointed out in this piece, suicide and its prevention are complicated. As the piece mentions, the American Assn. of Suicidology’s warning signs were never intended to be used on an individual basis outside a clinical setting — by people trying to help friends and loved ones.

Back in October, The Times produced a 24-page special section, “How To Save A Life,” focused primarily on suicide prevention. My colleague Thomas Curwen wrote a striking piece of journalism for the section that explores the struggle to save someone you love and grief that follows when that person dies by suicide.

Other interesting stuff

Pastor Thema Bryant, also a professor of psychology at Pepperdine University, this month became president of the American Psychological Assn., the nation’s largest organization of psychologists. My colleague Deborah Netburn wrote an incredible profile of her, including how Bryant identifies as a sexual assault survivor in nearly every talk she gives. She can do this, she said, because she is genuinely free from shame. “I believe and I know in my core that somebody else’s violation of me is nothing for me to be ashamed of,” she said.

Officially, colleges say that students can share as much about their mental health in application essays as they’d like. “But in practice, it seems clear that schools are nervous about accepting adolescents who divulge psychiatric histories,” writes author Emi Netfield in this New York Times essay. Should applicants play it safe and conceal their emotional troubles, even when it means leaving low grades and gaps in transcripts unexplained? Or should they tell the truth and risk getting flagged as a liability?

Addiction treatment has been one of the most closely watched areas of psychedelics research in recent years, as studies explore whether they could help people shake off the need for other substances, including alcohol and tobacco, writes my colleague Emily Alpert Reyes.

Guards in county jails are using pepper spray and stun guns to subdue people experiencing mental and emotional crises. Nearly 1 in 3 “use of force” incidents involved a person who was having a mental health crisis or who had a known mental illness, despite the fact that their severe psychiatric conditions meant they may have been unable to follow orders or even understand what was going on, NPR reports.