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Stuart Katz, "Still Here: A Story of Living with Suicidal Ideation" (Independent, 2026)
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- [02:07]
Stuart Katz
Welcome to the New Books Network.
- [02:11]
Interviewer
Welcome to the Van Leer Institute series on ideas. I'm Renee Garfinkel. Today's conversation will focus on a difficult subject, suicide. We talk with Stuart Katz, author of Still A Story of Living with Suicidal Ideation. It's a book that takes on one of the most misunderstood subjects in mental health. What it means not simply to experience a suicidal crisis, but to live for years with the recurring Presence of suicidal thoughts. Katz approaches the subject through a composite character, Daniel, a man who appears from the outside to be functioning well. He has everything family, work, community, friendships, and even spiritual commitments. Yet privately, he's engaged in a long internal negotiation with despair. That tension between the outward competence and inward suffering is one reason this book is important. Much of the public imagination still treats suicidality as something obvious, dramatic, or confined to people in visible distress. But the clinical literature tells a more complicated story. Suicidal ideation is not a diagnosis. It can appear across many diagnoses, including depression, trauma disorders, bipolar illness, anxiety states, addiction, personality disorders, and sometimes in people who don't fit neatly into any psychiatric category at all. Suicidal thoughts can be fleeting or chronic, passive or urgent, symbolic or concrete. For some people, it emerges in moments of crisis. For others, it becomes a background condition of life. Stuart Katz writes about that second group, the people who continue showing up for work, raising children, making dinner, answering emails, and carrying on ordinary conversations while privately managing thoughts they keep hidden. This population challenges many of our assumptions about suffering and about resilience and about mental illness. They may not look sick, they may not seek help, they may not even really want to die in any straightforward sense. Often what they want is relief, and that distinction is crucial. Some of the most serious clinical research has shown that suicidal thoughts can function paradoxically as a source of comfort, a mental exit door, an imagined form of control, a way to quiet unbearable psychological or physical pain. Emile Durkheim famously wrote about Anna Me and the social factors in suicide. Other writers, like Kay Redfield Jamieson, have explored the intimate relationship between mood disorder and self destruction. Stuart Katz's book enters that tradition from another angle, not as theory, but as lived, interior experience. What happens when someone has every visible reason to live, who wants to live, and still feels pulled toward death? Why do families, clinicians and communities often miss the signs? What kind of support helps when the issue is not a one night emergency, but a decades long condition? And how do we speak honestly about suicidal thinking without stigma or fear? These are the questions at the center of still a story of living with suicidal ideation. And they're the questions at the center of our conversation today. Stuart Katz, welcome to the podcast.
- [05:48]
Stuart Katz
Thank you.
- [05:49]
Interviewer
Stuart, what first motivated you to write about suicidal ideation as an enduring condition rather than a single crisis event?
- [05:58]
Stuart Katz
There, there actually are multiple reasons, you know, you know, why, why I wrote about it. Most people think about suicidal ideation, meaning someone is about to do something. And I would hear this over and over and over. And the reality is for millions of people. Suicidalization ideation is something that's chronic. It's there in the morning before the alarm. To many people, it has a number on a scale, often from 1 to 10. And the person carrying it goes to work and makes coffee. They say brachot for their kids on Friday night and no one knows about it. And that's what this book is about. It's not the crisis, it's the ordinary day. And I felt it was important to share. It's not something that's shared in for the. For the one that can get to clinician's office or the one who has family who thinks they understand. It's written for the people to understand. And that's what motivated me.
- [06:47]
Interviewer
How much of it grew out of your advocacy work and how much grew out of experiences in your own family and community?
- [06:55]
Stuart Katz
100%. 100% grew out of it. Out of a combination of advocacy, out of familial experiences, out of seeing things that I've seen throughout my life. Most of it I was blindsided to. I never knew what I was seeing. And I think most people don't realize what they're seeing. When people hear the word suicide, they're afraid of it. The advocacy work that I've done gave me the rooms. Years of sitting with people, whether in semi clinical settings and clinical settings and community settings and conversations that happen after formal conversation is over, when someone stays behind. I teach mental health first aid. When someone stays behind a course and wants to close the door and says the thing that actually they came to save, the reason they took the course those rooms gave me the raw material for still here. The specific weight of what people carry when they finally find the words. The exhaustion of a man who has been performing competence for 30 years and is for the first time able to say that he's not performing. Daniel in the book is not one person, he's many. He's built from the rooms of these people. The conversations that I've had, the accumulated understanding of what, what this actually looks like, and more importantly, what it feels like from the inside. Then there's the other side of it. Um, the book also grew out of something that advocacy work taught me that I couldn't find anywhere else in the literature, which is the people who need this the most are not coming to advocacy events. Um, they're probably not even listening to the podcast, so hopefully it'll be shared. They're not raising their hands in rooms. They are not in the room till we talk about mental health openly and without stigma and we have a long way to go there. They are the ones running those rooms. They are competent, community embedded function, high functioning, and if only people knew what they were carrying. So the advocacy work got me closer to see that gap, to understand the. The awareness campaigns that we're beginning to see in Israel and again, a long way to go, and the stigma reduction in Israel and throughout the world. It's not reaching everyone. So that got me to write it.
- [09:00]
Interviewer
And you invented Daniel as a composite character. Why did you choose to do that instead of writing a memoir or a bunch of case histories or even a more overtly clinical nonfiction book?
- [09:18]
Stuart Katz
When starting to write, I debated whether to write it as fiction or nonfiction, and I decided to go with a fiction because Daniel can go to places that a memoir in case history cannot. If we start with the case history. Case history is written for a professional audience. It often uses clinical language. It protects identifiable details, it presents material through diagnosis and treatment, and it's generally useful. Don't get me wrong, as a clinician, you know that. But it doesn't work for the person who's sitting in the synagogue, who's never been to therapy and doesn't think of himself or herself as someone with a clinical condition. Of course they don't have it. It's not in our family. It doesn't work for the wife who suspects something but doesn't have the language to use, doesn't know what to say. It doesn't work for the rabbi or the spiritual leader who's trying to understand what might be missing from his community. Case histories speak to people who are already inside the conversation. Daniel and still here, speaks to people who have never been inside it. A memoir? Why not a memoir? I wrote one already. It's called travel therapy. And what? Memoir is one person story. It has power and it has limitations. So when someone writes a memoir about suicidal ideation, the reader has two options. They recognize themselves in it or they don't. And if they don't, for example, if the memoirist is a woman and the reader is a man, or the memoirist is 23 and the reader is 58, or vice versa, they say, well, my situation's different, and they go back to carrying it alone. Daniel is a was written so that more people can find themselves inside of him. He's from many people, from many conversations, many rooms, many moments, and so on and so forth. So.
- [10:56]
Interviewer
So you mentioned a number of audiences for the book. Who was your first audience that you had in mind? The. The person with the thoughts or their families, clergy, Clinicians. What? Who did you have in mind?
- [11:10]
Stuart Katz
I guess you gave me a B, C, D, and I say all of the above.
- [11:13]
Interviewer
I left out the general audience, but yes.
- [11:17]
Stuart Katz
Right, right. You know, it wasn't a demographic or category or a specific kind of person. It was a competent individual. It was embedded. A person in his community, family person, a person known in professional circles, known for someone who's being solid. Was known as someone who was showing up, was the person people call when something's going wrong, a person full of life. But he never told anyone, didn't tell his therapist, didn't tell his best friend. When I say didn't tell, I'm talking about that he's having suicidal ideation. Didn't tell his best friend, not his wife, not the rabbi he's known for 30 years. He's managed to carry what he carries with great precision and self care and such care for so long that the management of it became invisible even to him. Everett Daniel never thought of himself as someone who's struggling. He thinks of himself as someone who has something he deals with in the morning before anyone else is awake, and then he gets out of bed and goes on. And that person was the first. The first audience that I was. That I was writing to was to him, and then it was to people around him, to Rachel, his wife, who senses something, but she can. She can't. They've been married for 35 years, but she can't name what it is. She knows that something's there but doesn't know what. To his children, to, you know, to. Dia has four children. He has one daughter. I talk about in the book Holly, who's a daughter, who calls her mother on a Tuesday afternoon book and says, I think. I think something is wrong with Abba. And she reached out independently without knowing her brothers were also reaching out the same week because something had changed in Daniel's voice. So it was. It was really for everyone. It was written for younger people in their 30s, for women who recognize themselves in him, even though he's a man, for clinicians, therapists and psychiatrists and social workers who read the clinical sidebars and then went back and reread Daniel's sessions with his therapist, Dove, and said, hey, that's my client. That's the thing my client isn't telling me, and then would go back to the next session, ask the question they hadn't asked before. I've heard from, besides the clinicians, I've heard from rabbis and community leaders that say, wow, this really hit them. And Then the one that surprised me the most, it's only been out a short time, were people who lost someone who were reading backwards and trying to understand who found Daniel's. I guess I'd call it Daniel's interior. Something that helped them make sense of what they had and they'd been able to see who was in front of them so long. Answer the first, the first audience was Daniel, the specific man in his 50s. It could be the 40s, 60s, but the book turned out to be for anyone who has lived inside this or beside of it, or someone who has loved someone who's still trying to go through it.
- [13:57]
Interviewer
Stuart, your book emphasizes how the mental health system fails people with chronic suicidal ideation. Your character Daniel is extremely fortunate. He has access to and he has the financial resources for outstanding exemplary treatment and support. Describe the ideal levels of therapeutic and other kinds of support that a person with chronic suicidal ideation ideally would get and talk about the costs they entail.
- [14:29]
Stuart Katz
Daniel is fortunate. And I, I made him fortunate deliberately because even with everything he has, the system still almost wasn't enough. He has a scope therapist he's seen now for six years. He has psychiatrist who monitors his medication. He has a couple's therapist. He has a rabbi with 30 years relationship. He has a best friend who himself is a psychologist, albeit in America. He has adult children who noticed something was wrong and reached out independently. And yet he never told his therapist a real lover for six years. And that's the point. If a man with all of that support and all of those relationships and all of that infrastructure can still sit inside Tuesday at an 8, a scale of 1 to 10, and not call anyone, the system is not. It's not only the failing. The people who have no access to it's failing in a much more fundamental way. It is failing at the level of the sealed room, at the level of one's performing self, the level of a specific kind of person who's built their entire identity around, around not needing what the system offers. So the system question is not only about access. And again, I'm not minimizing access because it's genuine and it's a devastating problem. But it's also about whether the system, even when it's fully available, is designed in a way that reaches the people who need it most. So that trying to answer your question, what does the ideal look like? Look, the first level I guess is individual therapy. But when I talk about individual therapy, I'm going to say it's the right kind of individual therapy. Daniel has Dove. And dove is good. But even Dove, a skilled experienced therapist with a six year relationship, didn't know the real number until Daniel disclosed it in crisis. The real individual therapy for someone sharing chronic suicidal ideation, it's not generic talk therapy. It is specifically trained. It knows how to ask the question differently. Not are you having dark thoughts, but what number are you at today or are you thinking of killing yourself on the scale that you used to tracking it. It creates a structure in which the number is a regular part of the conversation, not a crisis disclosure. It uses evidence based approaches. The common ones that we know of are dialectical behavior therapy, dbt, cognitive behavioral therapy, or cbt. Sadly, in Israel especially DBT is not done the way that the founder of it, Marshall Line, had desired. That's just a matter of time and a matter of money. Is it better than nothing? Sure. But those are therapies that are designed for chronic ideation. And there's other therapies that we hardly see in Israel as well. Hopefully one day they'll get here like parts therapy, whether it's TIFF or ifs. So the individual therapy is the first level that's needed. The second is psychiatric support. And when I talk about psychiatric support, I'm not talking about just the medication, which I call very transactional. We need regular relational psychiatric support. Daniel has Dr. Stern and he has scheduled with him 45 minute appointments four times a year where they do the medication review and a crisis resource list review. Again, I don't see that. Or I should say I haven't seen it in too many cases, certainly not in Israel. That's really, in my opinion, the basic floor. Um, it is better than nothing, much better. But it's the minimum viable version of psychiatric support. And even that's not ideal. We need more than that. So the ideal psychiatric relationship is more frequent, especially in high risk periods. It should be collaborative. The psychiatrist, the psychiatrist knows the therapy, knows the therapist knows community supports, knows what the patient is working on and adjusts the medication and conversation with that work rather than in isolation from it. He treats medication not as the primary intervention, but rather as one instrument in a larger clinical. I call it orchestra. You know, you got the whole band going. And the medication is just one, one instrument in that, in that band. And the most critical thing is the psychic psychiatric relationship is not only activated in crisis, and I see this day in and day out. Gotta call a psychiatrist and see what we should do. Well, Daniel psychiatrist adjusted his medication during the crisis period. The ideal version of that relationship would have Been tracking the signals that preceded the crisis, the increase in isolation, the erosion of the work structures, his number actually climbing and then responding earlier. The third area is the system itself, the system talking to itself. And this is where real failure lives. And it's basically universal. If we take a look at Daniel's case, Dove, his therapist, and Dr. Stern, his psychiatrist, they're operating in parallel. They supposedly, presumably know each other, exist. But as I show in the book, they don't speak regularly. They don't have a shared picture of Daniel's interior of his brain. They don't have a coordinated response plan. And the ideal that we need is an integrated care model. As therapists and psychiatrists and all others involved in his care and Daniel himself are in constant communication, of course, with his knowledge and consent. There's a shared safety plan that they all have to agree to. There are clear protocols for what happens if the number reaches a certain threshold and something that Daniel agrees to in advance. Calling Mata or the police or rushing someone to hospital ER is not the answer. That's actually going to leave more trauma than anything else. And this model exists. I don't see it too much in Israel. It's called collaborative care. It's practiced in some clinical settings. Not, certainly not enough, usually in larger health care systems that have the infrastructure to support it. But that's a. That gap is a policy failure gap. It's. It's a failure of funding and it's an infrastructure failure that's taken place simultaneously. The fourth level is the relational level, which I would include in that the family, the community, the rabbi, the clergy. This is the level the clinical system almost never addresses adequately. And it's for many people, the most important of all. Daniel has Rachel, but Rachel doesn't know. He has his children, but they only find out fragments. He has his Rav, Rav Friedman, someone who he's been with 30 years, who sends us something and asks directly. And he actually turns out to be one of the most important figures in Daniel's eventually opening up. He has his friend Ari, who doesn't know and who's not knowing is actually part of Daniel's loneliness. The ideal is not that everyone in Daniel's relation, what I call the relational world or the relational layer, knows everything because privacy matters, and I respect that. But the performing self has a legitimate function, complete disclosure to everyone. That's actually not the goal and it's probably not healthy, by the way. The ideal is that at least one person in the relational layer, one person who's not a Paid professional, meaning of the family, the community, or his rabbi who loves the person and is going to be there for them. He knows the number exists, or they know the number exists, they know what to ask, they know that I'm fine is not always true. And they've been given permission to say, I don't think you're fine, talk to me or let's talk. And that is in the book what Ralph Friedman provides. That is what Yigal provides his son Yigal, in a different way. Not through words, but through presence, through the coffee that they made through the night across the kitchen, you know, I see you, I'm here. Nothing is required. The fifth level would be community or institutional awareness. Daniel's rabbi knows to ask. And not because rabbis are trained to ask, although more and more they are, and they should be, but because Ralph Friedman has a 30 year relationship with Daniel and the wisdom and the courage. He can say to him bluntly, what are you not telling me? And the ideal at the community level is that people in positions of what we call pastoral care, which would be the rabbis, community leaders, have enough training to recognize the signals, enough language to ask the direct question, and enough clinical knowledge, even though minimal, to know what to do with the answer. They're not there to become therapists, they're not there to treat what they cannot treat, but actually the bridge to be the bridge to be the person who says, you need to talk to someone and I'm going to help you find that person and I'm going to stay with you while you do not just say you need to talk to someone and that training exists. I mentioned mental health first aid. There's a program called qpr, which is Question, Persuade and Refer. These are evidence based programs that can be delivered to community leaders in a day, and they're not being delivered in the scale that's needed. And the last level, and this is the one that the system really hardly ever talks about, is what happens after Daniel goes through a crisis. He discloses it to Dov, his therapist. His doctor adjusts it. Dr. Stern adjusts the medication. A couple therapy begins. He starts to open the room that we call the sealed room in the book. And then the book goes on for several more chapters. Because what comes after the crisis is not resolution. It's the long, the unglamorous, ordinary work of maintenance, the sessions, the, the inventory, the thought that may come at three in the morning, which is not its absence, which is not nothing, and it's going to be with him for the rest of his life. The ideal system does not treat crisis resolution as the endpoint. It actually builds a maintenance structure. The ongoing therapy, the regular psychiatric check in, the safety plan review periodically. I say a safety plan should be reviewed every three months. The relational layer activity that. The relational layer that we've just gone through actively maintain. This acknowledges the chronic nature of what Daniel and others like him are carrying and designs the support accordingly. The system as we currently know it is almost entirely oriented towards acute crisis. Get the person safe. We got to get them safe. That's first and foremost stabilized discharge. The chronic work. The years of a of a 3, the occasional 5 on the scale of 1 to 10. The vigilance that's required to catch a 7 before it becomes an 8, that's largely left to the individual and whatever therapeutic relationship they can sustain. And that's really, in my eyes, the deepest failure. And it's the one that makes Daniel's story the most visible. Daniel is fortunate, as you said at the beginning, by almost any measure. And he still almost wasn't enough. Which tells us something important about where the real work is. It's not only in expanding access to the system that exists, but in building a system that's actually designed for the people who need it most. That's the people who are performing fine. The people who have built their entire life around not needing help. The people who will tell their therapist it has been a difficult period and not tell them it's been an eight. That system needs to be built for Daniel. It needs to be built right now. And it's not. We need to do that.
- [25:37]
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- [26:35]
Stuart Katz
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- [27:34]
Interviewer
when you talk about the various people in the mental health system and outside who are need to be collaborative, use the metaphor of an orchestra. Who do you imagine as the conductor it could be?
- [27:50]
Stuart Katz
It could be. It could be anyone because there's excellent musicians. It could be anyone. And I don't think there needs to be a conductor. There's excellent musicians. We have a skilled therapist, competent psychiatrist, a rabbi with tremendous wisdom, best friend with clinical training, his children who are paying attention, spouse who senses something that she cannot name. So all of them are playing, but none of them are hearing each other. The the real conductor is Daniel. Daniel's become the conductor of his own concealment of it. And that's not that's not the system the way it should be. The conductor, probably in a ideal situation which we just stopped there is probably the primary therapist. And it's not because the therapist is the most important person in the orchestra, but it's because the therapist likely is the one with the most complete picture of the interior. And when I say the therapist, I'm referring to the person besides Daniel. Daniel's his real conductor, but the therapist is the one who hears the number. The therapist is likely the one who knows the history the greatest although in Daniel's case it's probably his rabbi or his wife. But the therapist has a clinical understanding. The therapist, the conductor therapists that I call them a conductor therapist here in this case they're not managing the patient. They're actually what they're doing is they're holding the score. They're holding the full picture and they're doing you know, but the real truth, the heart and it's really the harder truth is that even with a skilled conductor like the Therapist. There's the one instrument that cannot be conducted from the outside, and that's Daniel himself, the patient. He has to be willing to let the conductor, if we say it's the therapist, here are the real number. He has to be willing to say to the rest of the orchestra, to Dove, to Dr. Stern, to Ralph Friedman, to Rachel, to his kids. Not the manageable version, but not the summary. You have to be willing to say the real, the real number where it is. So I guess right now for most people carrying what Daniel carries, there is no conductor. There's a collection of very caring and loving people playing in separate rooms. They're not able to hear each other. And then the person in the middle is making sure it stays that way. And that system needs a conductor. The person needs to be willing to let someone hold the full score. And this has to happen. And neither of it's easy. But when they do, even slightly or partially, even imperfectly, imperfectly, it changes something. And in our book, what's important is Daniel is still here and that's what matters when these things happen.
- [30:35]
Interviewer
We know that suicidal thoughts also occur in non clinical populations. What would you say distinguishes the more ordinary existential or transient kind of suicidal thinking from the chronic identity shaping ideation Daniel lives with?
- [30:54]
Stuart Katz
Let me try to draw out this. Yeah, I'm trying to. I'm thinking, I apologize, I'm just thinking that's quite a clinical question. You know, what we know about suicide, suicidal thoughts in the general population is we have what we call passive suicidal ideation. And it's the kind that shows up in non clinical populations. And it's actually probably far more common than most people realize. Studies show that somewhere between, I mean, I've seen up to 50%, but most studies show between 15 and 25% percent of all people will experience some kind of suicidal thought at some point in their lifetime. I've heard a joke saying that it's up to 50% and the 50% who say they haven't are lying. So who knows? Many of those thoughts are fleeting, some are situational. They arrive often in a specific response to a stressor that could be an acute period of pain. I say they usually arise because of trauma, which is a different conversation in itself that remains in our bodies. But they're very alarming to a person experiencing them and often because they have no framework for understanding why that thought arrived. But they're very disturbing. And Daniel's experience is somewhat, I would say it's categorically different. And the difference is not just One of the duration or the frequency, although that they both matter. The difference with Daniel is one of structural. The first distinction, and we're going to get a little clinical here, is what's called the eagle. Syntonic integration. It's not experienced as intrusive or foreign. It's something that was been present in Daniel since his early 30s. It arrived, it stayed. And over almost 30 years, it become. It's become not what I would call it welcome, but it's become familiar in his body. It's known. He's built an entire life architecture around its presence. And that's the ego syntonic quality of chronic ideation. And what makes it so difficult to, you know, it's to, to. To explain and to understand the second. The second area, that is the person with acute situational ideation doesn't need a management system. The thought arrives, it's alarming, and it passes, or they seek help, but the timeline is very compressed. So that would be the second area. Another one is acute. Suicidal ideation has a relationship to time that chronic ideation doesn't have. You know, the acute in the acute indicator is in a specific moment of pain. And that chronic ideation just doesn't. Doesn't show that the thoughts connected to that moment. And when that moment passes, the relationship that the person's experiencing with themselves is actually repaired because the crisis is probably going to resolve. And if the acute stress is removed, the thought of suicide passes with it. So time is. Is the ally there? Sometimes we say it's the next 24 hours, the next week, but it's different. And for Daniel, time is not the ally in the same way, you know, because. Because it's chronic. The thought's been there for 30 years.
- [34:17]
Interviewer
Daniel. Daniel lives in Israel and where we've experienced the national trauma of October 7, 2023, and the war that has followed since. What is the dynamic, the interaction between private pain and general stress, in this case war, Missile attacks on the civilian population, but even earlier and more universal, the COVID pandemic, things like that.
- [34:47]
Stuart Katz
Let me start with something that sounds counterintuitive, actually. For the first few weeks after October 7th, Daniel's numbers actually went down. Um, and it's not because things were better, but because for the first time in almost 30 years, the inside and the outside were actually in alignment. The world outside of Daniel had caught up with what his interior had always known. That things are fragile, safety's constructed, the ground can shift without any kind of warning. The dread that he had been carrying privately, that he was Carrying alone that no one around him could see your name. Suddenly everyone around him was carrying something that looked familiar. And it felt, I guess I would call it, adjacent to him. He was no longer the only one who knew. There's a specific. It was a very complicated kind of relief and understanding. It is actually important to understand the dynamic between private pain and what we call what we know as collective trauma. Chronic suicidal ideation. By its nature, it's kind of a. It exists in a little illegitimacy. The person carrying it, in this case Daniel, who wakes up at 6:47 in the morning and notes the number for his day. Every day he gives himself a number and then buries it under the day had no public language for what he carried. October 7th changed that, or at least it did on a temporary basis. Suddenly the entire country was struggling. We're struggling openly, we're struggling collectively. We did so with full social permission. It was okay to feel this way. No. Nobody was asking Daniel why. He seemed happy. Everyone seemed happy. So for Daniel, that permission was complicated because he's not being fine predated the war. I have almost 30 years. And the release, the relief of having it legitimized from the outside was real. But it was also a. We'll call that kind of grief because what he was carrying was not the same as what the country was carrying. The. The other thing, what's also clinically quite significant, but also dangerous, is when October 7th happened, something shifted in the relationship between Daniel's suicidal ideation and the world around him. The thought, which had always been, in some sense private and personal and not quite rational, began to feel for the first time like a reasonable response to the situation. Not a symptom, but a conclusion. Okay, this is what's meant to be. Um, and he knows. Intellectually smart person, Daniel, and this is the cognitive distortion. He has the clinical vocabulary of years of therapy. He understands from the outside exactly what is happening. Um, the suicidal ideation is borrowing its own legitimacy from the collective trauma. Um, it's using the external situation to make the internal. His internal logic feel more defensible, more rational, more like a response to reality. And knowing that and living inside it are completely different things. So his inside's kind of saying, you're not being irrational. Look around. This is what I've been telling you. Like, look, everyone agrees now. And perhaps the most concrete answer to it is Daniel's management system. The architecture he built across 30 years to keep his numbers manageable, ideally below a 5, 6, 7 was external. It depended on conditions that the war removed. The international consulting work that he was doing professionally kept him moving. It gave him performing self like he was able to perform. He was able to fill a calendar completely. But what October 7th, and certainly when we saw when the Iran war broke out, the airports closed, clients got canceled, they didn't want to deal with anyone in Israel. The rooms he performed then disappeared. And the travel that gave him periodic relief from his life in Israel, the hotel rooms where he could be no one in particular, just for a few hours, the long flights where he could goodness perform himself, could rest. All of a sudden, we're gone. He couldn't go anywhere. The sense of professional purpose that gave each day a direction were diminished. And then this. The collective grief, which we can't ignore, it gives permission for certain kinds of suffering and not for others. Collective grief creates a hierarchy of pain. We all know that after October 7, the suffering was the suffering of the hostage families, of those that weren't coming home, the bereaved, the Salim, the communities that were destroyed. It was real and it deserved every bit of attention that it received. But Daniel's suffering, what he had been carrying since his early 30s, had nothing to do with October 7th and everything to do with his own interior. And before October 7th, he was invisible because the performing, his performing self was in it. And after October 7, he was still invisible because. Because the collective grief created a framework in which his particular suffering didn't have a place. It couldn't say, I'm struggling because of the war, because the truth was more complicated than that. And he couldn't say, I'm struggling because it's something I've always carried. Because that required a disclosure that he had never made. And this was double invisibility. And it was tremendously, tremendously painful.
- [40:02]
Interviewer
Finally, Stuart, when someone dies by suicide, family and friends are often left with terrible feelings of guilt. What did I miss? How could I not have known? And yet Daniel successfully kept his daily suicidal thought secret for decades. What is your message to family and friends?
- [40:25]
Stuart Katz
So the short answer is, it's not your fault. That's, that's, that's, that's real, real important that people understand. You may not have missed anything. You may have been looking with everything you had. You were paying attention, you were present, you were loving them with the full capacity of what love can do. And you still couldn't see it. And it's not because you failed. It's because they were extraordinarily skilled at making sure you couldn't. When someone we love dies, by suicide. And we find out afterwards what they were carrying. Even if we knew it, the instinct is to make it about the relationship. We can find ourselves saying, if they had trusted me more, if I had been easier to talk to, if our relationship had been different, better, closer, maybe they would have told me. And sometimes that's true, that's true. Because relationships matter and connection is protective. And the researchers are very, very clear about that. If Daniel had died and there were mornings where he almost did, the people who loved him would have spent the rest of their lives asking these questions, what they missed. And the answer, the honest answer, is probably nothing you could have seen. And it's not because they weren't looking. It's because he was good at hiding it, because that was the primary project of his interior life. And the second thing is, the hiding was an act of protection, not rejection. And this is the things that family and friends carry. The sense that the person didn't trust them, they didn't believe, they couldn't handle it, they chose not to let them in. And there's truth in that, by the way. Our performing self doesn't make a calculation suicidal ideation, especially chronic suicidal ideation. It distorts the calculation that we're making. It tells the person that they're a burden, that the people who love them would be better off, not worse, without the way to knowing that, to discloses, to damage the very relationship that makes stain possible. Third thing is, and these are questions that help and they're hard to ask. But for the people who are somehow besides someone now, who they suspect something, who sense the gap between what the person they love or the person they know presents and what they might be carrying, this is the message. And I can say this in no other words. Ask directly, not are you okay? Ask directly, are you having thoughts of suicide? Are you thinking of killing yourself? I know that person. That question feels dangerous. It's a difficult question. I know the fear that it asking it plants the idea. And the research on that is unambiguous. Asking the question does not plant the idea. It actually opens the door. And sometimes the door has been waiting for 30 years for someone to knock. It's going to be uncomfortable. The person may deflect. The performing shout may produce a smoothing, convincing answer that sends you away reassured. Ask again, keep asking. Not accusatory, not in a way that corners are frightening, but with the specific, steady, loving presence of a person who was saying, I see you and I'm not going anywhere. And Daniel kept his thoughts hidden for nearly 30 years. And not because the people around him failed him. Because he was extraordinary, extraordinarily skilled at keeping them hidden. And because the illness itself told him that the hiding was the loving thing to do. So if you've lost someone and you're carrying the question of what you missed, I want you to hear this. You were probably looking, you were probably paying attention. You probably loved them in every way you knew how to love them. But it's not your fault. It's the nature of what they were carrying. And the most important thing that you can do now, not instead of grieving, but alongside it, is to think about who else in your life might be carrying something similar. To ask the direct question, are you thinking about suicide? To knock on the door that might be waiting for someone to knock? Because the person inside you right now, besides, excuse me, the person beside you right now, the one who seems fine, the one who shows up, the one who holds the room, who might be doing the same thing Daniel did every morning before the alarm, is alone. But right now, they're still here.
- [44:26]
Interviewer
The book is still A Story of Living with Suicidal Ideation by Stuart Katz. Thanks so much for talking with me about this extremely important subject, Stuart.
- [44:39]
Stuart Katz
Thank you for having me.
- [44:40]
Interviewer
And thanks to our researcher, Bela Pasakov.
- [44:56]
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