Podcast: Dr. Blaise Aguirre Gets Real About Teen Suicide and “13 Reasons Why”

Episode Transcript

Trevor: Welcome to Mindful Things. How’s everybody doing today? Welcome back. Our regular listeners, welcome. New listeners, I have apologies to make. It’s been four weeks, it hasn’t been two weeks, it’s been four weeks, and that was due to ... Well, you know, every ... This is actually my first time doing a podcast, and not only that, learning the workflow of a podcast. My background is in video and film, not so much in audio, though I know a little bit. And sometimes I’m not going to get it right.

We have what I like to call a standards and practices committee that goes through the podcast, and the last one didn’t get approved. It happens. Hopefully next time that doesn’t happen. We’ll have another episode on backup so we can stick to our two-week schedule, but we did not this time, and so we went four weeks. For that I apologize. I’ll do better so that we can stay on schedule.

On today’s episode, we are going to interview Blaise Aguirre, who is a child and adolescent psychiatrist. He’s a medical director here at McLean Hospital. And what we’re talking about today is a study that was published in the journal of the American Academy of Child and Adolescent Psychiatry regarding the TV show 13 Reasons Why. And that teen suicide went up by 28.9% in the month after the premiere of the show. And we talk about the show.

Blaise has seen the show. I’ve seen a few episodes. We talk about our impressions of the show and this study. And I thought this interview was timely because the Game of Thrones finale had just aired, and everybody is acting like it’s the end of the world. So, yeah. It’s a fascinating world we live in.

I went to the movies yesterday. It’d been a while, and I was like, “You know what? I have the day off, I’m going to go see a couple of movies.” I went to go see Olivia Wilde’s new film Booksmart. It was excellent.

But I also went to go see a film that I’ve been dying to see for a while now. It’s called Amazing Grace. It’s a documentary about a church performance that Aretha Franklin did in 1971. The film had never been released. And it features her performing gospel music. No offense to anybody, I’m not a religious person, I’m not a person of faith, but I actually do like gospel music, and then I really like it when Aretha sings it.

So I went to this documentary. I went to an 11:15am show. Expected it to be quiet. I’m always wrong. I’m always wrong when I think like that. I go to the movies a lot. Not as much as I used to, but I go to them a lot, and I hear other people complain how teenagers are so rude at movie theaters, and I go far more than the average person. So I notice that it’s actually teenagers that aren’t the problem, it’s ... I hate to say it, a lot of the problems that I’ve run into, it happens during matinees, and it’s with people who are older, and they just don’t have any respect for people around them. And they get on their phones, and if you ask them, “Can you turn off your phone, because it’s really bright?” they tell you to mind your business. They talk out loud. They just talk out loud through the entire film. I mean, full voices, everything. You ask them to be quiet, maybe they do, but most of the time they don’t.

This is a problem I’ve run into consistently. I don’t think it’s kids. I just think it’s rude, entitled people. And we had plenty of those in the audience yesterday when I went to go see the documentary.

Now, to the right of me was somebody talking so loud, and behind me was somebody that kept kicking my chair. And I’m becoming so furious that I can’t even focus on the movie. Well, Trevor, just turn around and just kindly ask the person, “Can you stop kicking your chair?” Or turn to the right and say, “Could you please not talk so loud?” Or, “Could you at least whisper?”

You’re absolutely right, I could do all of those things, except I’m not capable of doing those things, or I’ve convinced myself I’m not capable of them. I have two modes. I have I just stay there quiet and stew, or I turn around and just scream and use a bunch of profanity. “Shut the F up.” Or, “Stop kicking my effing chair.” You know? And that’s no way to approach things.

So instead ... And I know that. So instead I just sit there, and I stew, angrily. And I just don’t enjoy the movie. And it’s so funny, I even prepped myself for this movie. I took my meds right on time in the morning. I took a CBD lozenge so I’d be not high but just chill during the movie. Just relaxed. I wanted Aretha’s voice just to take me somewhere. And no. No, that didn’t happen. I felt like I didn’t even see the movie, you know? I saw it, but I wasn’t able to take any of it in. I was so angry.

And let’s talk about that. I was so consumed with my anger that I couldn’t even enjoy anything around me. Usually at this point I’m supposed to provide some sort of, “Well, what did you do about it?” If you’re avoiding conflict, was there any mindfulness exercise? Was there anything ... No, I didn’t do anything. I just chose to sit there and be angry. And that did nothing for me. Nothing.

This is something I need to work on, and I don’t know how to do it. There is a yin and yang component to it, and I feel like I need to be on one side or the other. And what’s ironic is that in my interview with Blaise, I talk about how there’s areas of my life where I’m in the gray area, and I wish I could be in the black and white areas. Well, there’s also areas where I’m in the black and white, and I need to be in the gray. And there has to be a compromise, or a happy middle for lack of a better description, that I can find that can satisfy me so I can sit down and enjoy the film that I’ve not only just given my money to see, but I’ve given my time to see.

And yeah, I think I was upset and frustrated for good reason, but there was no reason to be that angry, to be that upset, to be that consumed by something, that I wasn’t able to enjoy whatever was in front of me—and was too afraid to face the conflict because I was afraid about how I was going to approach it. And then I was also afraid of how they were going to react, because if I come at them swinging, not literally, but if I come at them with force, anger, harsh language, I mean what is ... How are they going to react? I imagine they’re going to react the same way, and then it’s just a matter of one-upping each other until somebody else steps in or a manager comes up and throws us out. Nobody wants that.

And the few times that I have, and it’s been a few times, I have asked people kindly to be quiet, one guy threatened to beat me up. I’ve always said I have a face that you just want to punch. And I kindly asked this person. And then another time, I yelled. I got up, I mean, it was a father and son. They were so loud during this movie, so loud. I mean, not even full voices, amplified full voices. And I turned around, and I yelled, “We’re all trying to watch this movie, could you please be quiet?” But I yelled it. And I was harsh. So yeah, I said please, but it was loud. And they were quiet for about 15 minutes, and then they just started in again.

So I’m approaching these situations with anger, and the past experience where I tried to face the conflict, one time I felt I did it correctly, and another time I didn’t. Both had negative results. So that’s in my mind. And I’m stewing about that, and I just can’t even pay attention to the movie. And if anybody’s seen Amazing Grace, it’s ... For those people that I’ve talked to that have seen it, you just get sucked right into it. I could tell I was watching something really ... My eyes were seeing the reflection of the light off the screen. I could tell that there was something brilliant in it. I just wasn’t experiencing it. And I’m really, really, really upset about it. I hate when movie experiences are ruined for me. That may be petty, but I hate it.

So what do I do? I don’t know. Try next time to just politely and quietly ask somebody to please be quiet, or to stop kicking my chair? Sounds sensible, right? I have no idea. Sounds easy, but not for me. We’ll see.

Trevor: Okay, Blaise Aguirre. We’re talking about 13 Reasons Why, and I hope you enjoy.

Blaise: You know, I, in South Africa growing up there, I had the situation where I loved Saturdays, because Saturdays was movie day, and I could just go there, and I could also watch all day. And I loved the movies tremendously. And I was thinking about this the other day when I would ... Because I would just go and spend from 10 till four, I’d go from one cinema to the other just to watch whatever it was.

I imagined sitting in a movie, I was thinking about this the other day, and all of a sudden I’m watching the screen ... The great Vietnam ...

Trevor: Apocalypse Now?

Blaise: Apocalypse Now. Watching Apocalypse Now, just getting totally—

Trevor: Let me ask you, how old were you?

Blaise: I was probably around 16, 17—

Trevor: Yeah, that’s the first time I saw it, and it’s a hell of an experience.

Blaise: Incredible—

Trevor: Hell of an experience.

Blaise: Incredible experience. It was. But I was imagining, because I got so immersed into everything that was going on, that all of a sudden on the movie screen I get a text that’s saying, “What’s going on?” And then I get a message on the movie screen saying how ... distracting, and how ... Wait, what just happened—

Trevor: What? I don’t understand.

Blaise: Because in today’s day and age, when I watch children and other people watching the movies that they are, they’ve got their cell phones out.

Trevor: Right.

Blaise: They’re watching a movie, but they’ve got their computers on their laptops. So what I’m saying is that the experience of just even that is ... We didn’t have the ... I didn’t have a cell phone when I went to the movies back in the day.

Trevor: Right.

Blaise: I wasn’t ... I could get myself fully into it—

Trevor: Immersed, yeah.

Blaise: And I’m just saying that even today that when people are talking about it, even when ... “Star Wars” or whatever it is, everybody has lots of these other things happening. They’re texting real time there. Posting on everything. It’s a different experience. I just find it hard to imagine how one could immerse oneself in that kind of way that you just described.

Trevor: So that’s funny. I go see a lot of films.

Blaise: Right.

Trevor: And the thing is, is that if you want that experience again of not ... of not the cell phones, you literally have to go out and find that community. We’re a dying breed. The film goer is a dying breed.

Blaise: Absolutely.

Trevor: Of people that go in, and we are there to be immersed together. Because it is a ... There are some films that you’ll watch, everybody’s immersed in it. But then you go home and see it again, and it’s not the home experience. It’s the fact that you’re not with a crowd, which is why the film no longer maybe holds as much weight to you. Have you ever seen Network, the satire from the late ‘70s about news and—

Blaise: Yeah, yeah, yeah.

Trevor: Okay. That film is a masterpiece all the way around. That film with a crowd is insane.

Blaise: Oh, that’s interesting.

Trevor: It’s insane. People, they’re laughing, they’re dying, they’re grumbling, they’re angry. But can hear from people—

Blaise: To me Rocky Horror was like a ... I mean just—

Trevor: I’ve seen that many times in the theater, and it’s—

Blaise: Right. And everybody.... Said—

Trevor: Right.

Blaise: But I also think even a ... And I’m not saying that a chair should be uncomfortable, but the fact ... I was watching Get Out, and—

Trevor: Great film. Great film.

Blaise: Great, great, great film. But there was something about being in this really comfortable AMC chair with the food and everything like that. It took ...

Trevor: I’m with you—

Blaise: It wasn’t exactly the same.

Trevor: I—

Blaise: I’m not saying, look, I enjoy being comfortable. I’m not saying we should sit on hard wooden chairs, but there’s something about the person next to you ... I don’t know.

Trevor: I am with you.

Blaise: Yeah.

Trevor: But as a filmgoer I keep conceding on the film-going experience because I don’t want to see it die—

Blaise: No, I agree—

Trevor: And it is dying—

Blaise: Yeah, it is. I know that movies—

Trevor: It is.

Blaise: That’s why they have so much more space they can put these seats in, because everybody’s ...

Trevor: Right. Because ... And then they say, “No, these Marvel movies are keeping it ...” No, no, no. This is, in my opinion, this is the last gasp.

Blaise: Yeah. Yeah. Yeah.

Trevor: And cinema is now going to go the way of, and it’s okay, it’s going to go the way of opera and stuff like ... It’s going to be for a ... There will still be movie theaters—

Blaise: Absolutely.

Trevor: But it will be for a set group of people.

Blaise: Exactly.

Trevor: And everybody else will watch it at home.

Blaise: Exactly. Exactly.

Trevor: So the whole point of this conversation is surrounding the show 13 Reasons Why and that there was a study that said after the first season teen suicide went up by 30%. Now, as someone with a mental illness who’s so emotional and so emotionally sensitive, that can be moved by a piece of fiction so much that it may affect my ... I’ve bawled my brains out for hours over films that really didn’t deserve my tears, you know? You go back later, and like, no, I was just ... I was having a day that day apparently.

Blaise: I cried at Notting Hill. I loved that one—

Trevor: I saw that in the theater. I thought it was a very good film.

Blaise: Yeah, I did too.

Trevor: Okay, sorry guys, I’m going to get off on a tangent.

Blaise: Right.

Trevor: That writer, Richard Curtis, he’s a very good writer.

Blaise: Fantastic writer.

Trevor: One of my favorite comedy scripts is Four Weddings and a Funeral.

Blaise: Oh, that was great.

Trevor: Do you know how many times he re-wrote that?

Blaise: Yeah.

Trevor: 30 times.

Blaise: Wow.

Trevor: He re-wrote it 30 times, and that’s why it’s perfect.

Blaise: Right.

Trevor: That’s why you can feel every beat. That guy has discipline. Unfortunately, sometimes he gets saddled with a director who ruins his scripts, but I mean ... Yeah. Notting Hill, Four Weddings and a Funeral, the one around Christmas—

Blaise: That was great. But I do ... To your point, I tend to tear up tremendously during those kinds of ... I consider myself very, very sensitive in that way as well. So …

Trevor: But have you ever encountered something that really pushed you into an area that went beyond what your definition of entertainment is? I think everybody has a definition of what entertainment is.

Blaise: Sure.

Trevor: For example, the films of Stanley Kubrick, he directs in such a way that they do psychologically get in my head. The Shining, a film that I find absolutely terrifying, isn’t really as scary as I make it out to be, but his use of subliminal imagery, the sound design, the craft of it all ... Even the films of David Lynch, they do get in my head. And they scare ... The film doesn’t so much scare me as in the thoughts that are in my head when I go to bed. These scary thoughts, this imagery, this sound. Not of me doing things to other people, but what the film ... what was in the film.

Blaise: Well, I think ... Okay, so to me the most terrifying movie of all time ... But you see, I think it also depends on context and time—

Trevor: Absolutely.

Blaise: Because I saw The Omen as an 18-year-old Catholic boy, and I was just absolutely terrified. My son, who is 15, who loves, loves, loves movies, he said, “I want you to show me the scariest movie ever,” because he doesn’t get scared. Because often a lot of the so-called scary stuff is about aliens coming down, and he says, “I just don’t believe that’s happening, so it’s not that scary.” And also having grown up very Catholic, and stories of hellish afterlife, that that kind of thing got into my head. I showed him the movie and he said, “That wasn’t scary.”

Trevor: Right.

Blaise: He found Get Out much scarier than that. And that’s because he says, “I can imagine people doing that to people.” The idea that somebody’s ... a monster twirling your head, what’s that, you know? But I remember there were movies like the Steve Biko story, or some of the South African freedom-fighting movies that got me motivated and activated, but not in the way that ... Maybe it was an awareness, like in Cry Freedom, where—

Trevor: I never saw that.

Blaise: Yeah.

Trevor: Yeah.

Blaise: But where I would say to myself, “You know what? Maybe I’m not fighting hard enough.” So it activated an urge in me to do something. Or maybe I would see something and say, “Oh wow.” Like, I saw a movie where people were skydiving, and then I decided okay, I wanted to skydive, and I went, and I did skydiving. I mean, it influenced in terms of opening my mind to another possibility, but there was a separation between what was going on in my head and the reality ... What I was seeing in the movie in terms of okay, oh, that’s interesting, I think I will do that. But it’s not that it’s about me. It wasn’t a personalized thing.

But I think that there is levels of human experience where if you take steps, and you can begin to identify more and more and more with certain characters, and maybe because of the resonance of what those experiences are relative to your own experiences, you know ... I mean, I could never be in Alien and Predator, but I could be a Catholic schoolboy who was afflicted with corporal punishment and sent to naughty priests. That would resonate a lot more with me than something that was ...

So, quite what the impact is depends, I think, on your age. On your emotional context, the people around you, the people that you can talk to and all of those sorts of things.

Trevor: So what are these kids seeing in 13 Reasons Why? Because this is what I’m seeing. In the two episodes that I’ve watched, I’m seeing a show that has some good character actors that I recognize who have to say very poor dialogue. That’s what I see right there. I see a narrative structure that’s kind of pathetic. Even though Twin Peaks in a way used the same structure, there’s a dead high school girl and then there will be this mystery around her. Twin Peaks used the same exact thing, but that was a murder, this is a suicide. And I just see really wonky writing, and I’m seeing some decent actors trying to do the best that they can. And I see directing that’s very straightforward.

That said, if I think about a lot of the stuff when I was a kid or a teenager that emotionally moved me, I’ve gone back to a lot of the cinema that I loved as a child and a teen, and most of it turned out to be garbage.

Blaise: Right. Right, right, right. Right.

Trevor: And then you’d be surprised by some of the stuff that’s still held up.

Blaise: Right.

Trevor: But I remember when I was a kid The Goonies was a great movie. And let me tell you, I’ll watch The Goonies, it’s a fun movie, but it’s not very good.

Blaise: Right. Right.

Trevor: It’s just not.

Blaise: Right. Right. Right.

Trevor: But it’s fun. And it reminds me of my childhood. It reminds me, my friends, my family, watching it with mom, eating pizza and stuff like that—

Blaise: Exactly. Exactly.

Trevor: What I want to know is what are they seeing in this show? What do you think they’re seeing in this show?

Blaise: Yeah. Well—

Trevor: Or can you not answer ...

Blaise: Here’s where I think it gets interesting. But let me just make an analogy. If you pulled out a bowl of peanuts that we can have during this podcast, and then you said to me, “Here, have some peanuts,” and I said, “Well, you know actually I can’t. I’m actually super-allergic to peanuts.” So I’m going to be impacted differently from a different guest who isn’t allergic to peanuts. Because if I’m allergic to peanuts, well, there might be people who are supremely allergic ... I mean, you have even ... Just anything in the air, versus ... So there’s degrees to it.

And I’m saying that as a way of comparing an impact on someone who’s more sensitive and more vulnerable to someone who’s less sensitive and less vulnerable. But what we know that at this time, here in the United States, where teen and adolescent suicide, if you compare to the Western world, is three times higher than many other countries in the Western world. Where our children and adolescents are medicated three times more than many of the children and adolescents in the Western world. Why is there so much despair? Why are people being more medicated? And yet we’re having, in many ways, poorer outcomes? So—

Trevor: I have an answer, but it’s for another show, and they would bleep it out. They would make me cut it out anyway, so—

Blaise: And I can ... I’d probably agree with you. So I think that there’s so much despair in our teens. And the other thing is, I mean you were talking a little bit about this, about the influence of these images that you would see as a child. But now, what happens is that we can curate real-time images. So one thing is to have to wait an entire week until you go and see the next movie, but now instantly I can see curated images. It’s like, “I think your hair’s a little bit wrong.” I said, “Oh, okay, I’ll go and Photoshop it differently.” And now I’m looking more fabulous.

So it seems to me that adolescents and children are much more influenced by those kinds of images and that kind of sensitivity than they were many, many years ago. I see that ... I’ve had kids who come in who say, “My boyfriend’s ex-girlfriend liked a photo on Instagram, I think I should kill myself.” I mean, what?

So when you see these kinds of shows, in an at-risk population, and I think more children and adolescents are at risk, in an environment that isn’t paying attention to what their reactions are ... Because we as adults might say, “Well, it’s okay. I’m worried about it, go and talk about it.” But if you’re unprotected, and they’re allergic to peanuts, in the sense that they are hyper-sensitive to this kind of thing, the idea of ... The ideas that get planted can grow and germinate.

And the other thing is that the brain has a very difficult time distinguishing between reality and familiarity. So something that’s familiar ... Santa Claus, to let your listeners know, doesn’t exist. But he’s familiar, so he becomes real to us, right? And the same sort of thing. It’s like if I’m at risk and I’ve been thinking about all the break-ups, and I’ve been thinking about social media, I’ve been thinking about being bullied, and I see this, interesting idea. If I’m at risk for it.

So yeah.

Trevor: I want to make a point out of the familiarity. There’s ice in this drink.

Blaise: I believe you. I could check. I could see the reality. You could open it and show me.

Trevor: Right. But if you came from a life where everybody drank their drink with rocks in their drink instead of ice, you might have a moment of pause there.

Blaise: Right. Right. It’s true. Yeah.

Trevor: Even if there’s definitely ice in here.

Blaise: Right. Right. Right. I would think, “Oh, he also puts rocks in his drink.”

Trevor: Right.

Blaise: Because that’s what’s familiar to me.

Trevor: Right.

Blaise: Right.

Trevor: This is ... To me, speaking personally, I’m speaking for myself, that line, that’s very terrifying to me. It’s scary.

Blaise: Yeah. Well, you know there’s this idea in mentalizing, they call it psychic equivalence, and that is that I believe something to be true and therefore it is true. So if I believe that you are questioning why you ever invited me onto your show, then I think, “Well, that’s just true. So therefore ...” And then I storm out of here, because I think how can you be thinking those thoughts? Because I believe that to be true. And when I can’t make that distinction between un-checked facts and whatever is going on in my head, then it is problematic. And you are right to be scared. Because of where it can take people.

I mean, if it were trivial, it wouldn’t matter. But I think in terms of mental health and mental wellness, if I really believe that these are solutions to life’s problems, and they’re portrayed as such and I really believe them to be true, well then we can see what happens. Yeah.

Trevor: Do you think that sense of self, or self-definition plays a lot into this? I have a poor sense of self. I was in self-help group here at McLean for a long time. I still don’t know who I am, don’t know what I’m about, and therefore ... I’m scared admitting this on a podcast. It’s very easy for somebody to make me question myself.

Blaise: Right. Right.

Trevor: Very, very easy. Because I lack that confidence in who I am because ... I mean, I have confidence issues anyways, but the lack of confidence in this specific issue is because I still don’t even know who I am.

Blaise: Well, but you see this whole ... We get so caught up in this whole thing of sense of self. Because let’s just say, okay, is your right hand yourself?

Trevor: No.

Blaise: Okay. So let’s just cut that off.

Trevor: Okay.

Blaise: So that we can—

Trevor: Do you see how quickly I said, “Okay?”

Blaise: No, no, right, okay, so we’re there. Okay. So what about your left hand?

Trevor: It’s not.

Blaise: Okay. So let’s just cut off all the non-self parts.

Trevor: Right.

Blaise: What do we have left?

Trevor: Right.

Blaise: Because I think when we think about the self ... But let’s just say ... Okay, let’s say the self is anything that has human DNA in it. So I say, “Okay, but do you know that your body has more bacteria in it than human cells? So there are more bacterial cells in you than human cells, so let’s take out all the bacteria.” Well, then you can’t exist, because there is no self without all of these bacteria.

If you start removing all the non-human elements from the self, what’s left? So the only thing that’s possibly left is whatever’s going on in the small section inside of your head that begins to define it that has questions of your value system, questions of your enduring psychological patterns. And then how malleable are those? Because I don’t actually know exactly what that self is.

But people could say, okay, if your mom were to come in here and see you, then she’d say, “Oh, I recognize you,” because there’s some features. And then if you acted in a certain way they’d say, “Okay, those are familiar patterns to me.” It’s sort of the familiar patterns that show up that ...

But the idea is that we’re influencing each other, so okay, where’s the self in all of that? And maybe I get you thinking about something, well, has that shifted your sense of self. Or if we had photographs of you from a child to today, is that the self? Is that the self? Is that the self at three? Is that the self at four? Is that the self at five? It’s constantly changing. It’s constantly changing, and things are constantly changing. The two-year-old you doesn’t have a beard. Something changes along the way, and those are influences.

Now, for some people there’s a rigidity in terms of sense of patterns, in terms of their value system, you know? I’m always against this. In terms of their faith. I always believe in this. In terms of their predictability and what they do every day and that’s it. And maybe they see themselves, which is still a delusion, as if that’s the me that I am.

But for those of us who have flexible thinking and more dialectical thinking and see things from different points of view, and can move around and that, it can be unsettling, because then it’s ... It’s wait a second, I had this thought, but now I have this thought. And mostly the other thought happens because you have new information. So somebody tells you, “This is the way to think,” and you say, “Okay, well that kind of makes sense.” But then somebody says, “Oh, what about this?” And you say, “Oh, wait a second, that also makes sense.”

Trevor: I have today that DBT has actually been ... And I’m speaking for me, myself, not any other person who’s going through DBT ... and I think this is a phase.

Blaise: Yeah.

Trevor: But I’m going through a phase right now with DBT where I’m ... It’s scary, because I’m always in the gray now. I have this thought, but then there’s this other side, and I really can’t draw a line in the sand right now because these are two very complicated things. And they don’t cancel each other out.

Blaise: Exactly.

Trevor: And I think what this is telling me is that I need to learn to be comfortable in this place. That sometimes ... It’s the black and white thing that we were talking about. I can’t be in the black, and I can’t be in the white. I’ve got to be ... If I’m going to look at the entire picture, I’ve got to be in the gray. I think right now, because what I do is that I always subscribe to things extremely and then I balance myself out. I think I’m on this extreme side where I feel like I’m going to be stuck in the gray and I can’t make a decision about anything.

Blaise: Right.

Trevor: I think this will pass.

Blaise: Right. Right.

Trevor: But it is a scary place to be.

Blaise: Yeah, but I think ... If you were to say ... I mean, think about the person that you love most in your life. That if I went and I pushed them and you would say, “Well, on the one hand ... “

Trevor: That’s a very good point. That’s a very good point.

Blaise: All I’m saying is that A, remain curious, B, not to get stuck in insisting on some point of view. But that there are some things in life that ... That would just be okay, like if you did that. Now, possibly the reason I pushed the person that you love dearly is because there was an oncoming car, and I pushed them out of the way. I mean, to sort of slow that down and say, “Wait a second, did I miss something?” But that there are going to be some things that you just say, “No, this is wrong.” And as long as ...

Look, when I came from South Africa I believed in the death penalty. I totally don’t believe in the death penalty now. But I mean, could you point to certain situations where I would say, “Well, okay, except in that situation I might understand.” Maybe it’s a dictator of a country who has brutalized their people and that it has such psychological toxic ... Could we say, “Well, maybe?” Those sorts of things.

But it’s allowing new information to come in, and then just seeing that okay, I have these perspectives. But I think that a show like 13 Reasons Why can lead us to those very polarized positions. It’s a terrible show. It’s a great show. And I say okay, well, I can see how each of those positions makes sense. You can make a case for each of those positions. And I could argue either side. But it’s also taking a more nuanced perspective and thinking ...

What’s the new wisdom that arises from this thing? Because we can’t un-see 13 Reasons Why for those of us who’ve seen it. It’s not like ... Okay, one day we’ll be able to go with optogenetics and change individual memories. But yeah, I mean, I don’t know.

Trevor: I want to say for the listeners, it’s not like I’m shitting all over this show. Believe it or not, I actually do want to finish it, because I do think that the storytelling is poor, but I do want to find out what happens. I think that’s ultimately the big hook the show has is that at the end of every episode, I’m like, I do want to find out what happens.

I never like to ... Well, I used to when I was younger. I no longer like to tell people how to watch something. But this is a different situation.

Blaise: Yes.

Trevor: How should teens be approaching this show?

Blaise: So there is no question that there are certain young people who, in watching this show, will get activated to the point of maybe wanting to seriously consider this. And then other people who might say, “Oh, that’s kind of interesting.” And others who say, “This is just boring, I have no interest in this show.” And that the impact that it would have on a five-year-old, versus a teen, versus a young adult, versus a parent is going to be different.

Trevor: Right.

Blaise: The context under which they watch the show is going to be different. So if you would say, okay, what if somebody binge-watches it in isolation versus watches it in a group?

So I think for any show, irrespective of the topic, that has the potential to cause, and I’m going to use harm with a small “h,” meaning that that could activate someone to become more suicidal or even act on it, ought to be watched with, certainly parents, if they could. Other people if they could. And that there be an agreement to have a discussion after it.

Now, one of the things that you and I were talking about a bit earlier on was that what’s going to happen to cinema? If I am a 14-year-old who wants to download it at two o’clock in the morning when I’m feeling isolated ... Now we can get what we want when we want it, whenever we want it. And so for me, one of the problems is the situation where kids are watching it on their own who are at risk. And I think that ... If I were a parent, and worried about this, I would be asking my kids directly, “Hey, have you watched this show? Do you know anything about it? Has it impacted you in certain ways?”

But if I were the parent of a person who had mental health concerns or issues, who maybe was seeing a therapist, I would be particularly worried. I mean, again, if I had a child who was prone to allergies, I would want to know if they were allergic to peanuts. And somebody who’s more at risk, I would want to be particularly careful.

But if you think about this, you say, “Okay, that’s just not reality because 13 Reasons Why,” but we turn on CNN News, we turn on Fox News, and we see the toxicity of contemporary politics, and I see despair in many people, hopeless about their situation. Other people enriching themselves, or other people despairing about divisiveness in our country. You can say, “Well, that’s reality.” Well, but there’s also reality that children today and adolescents are suffering.

So I think having an openness to real discussion ... When people are getting more upset about Game of Thrones than of the Mueller investigation, for example, you know—

Trevor: I gave 73 hours to Game of Thrones. And I couldn’t even give myself a couple hours to the Mueller report. I downloaded it, I started reading it. And I’m not even talking about the report. I downloaded the 18-page summaries, part one and part two. And I started reading it, and I was like, “I don’t got time for this.” Really? I don’t have time for this?

Blaise: Right. Right. Yeah. But I mean, if you think about it, under what circumstances would you have had time for it? If you were to think about ... What would’ve induced you to read the entire thing? If what? If by reading it, then what?

Trevor: If I worked in Washington?

Blaise: Yeah.

Trevor: If I was there, then I would feel no matter where I was in the aisle that I should read it.

Blaise: Because why?

Trevor: Because it’s my job. It’s my responsibility. It’s my duty. I’m a public servant.

Blaise: In order to do what to it?

Trevor: Yeah, that’s a great question.

Blaise: Well, but I mean, if you think about ... For people who feel that they have some degree of power, some degree of say, and that what they think means something ... If you truly say, “Oh, by reading this I’m going to understand things in a different way”—

Trevor: Yeah, and then for what?

Blaise: But if you were to say, “Oh, and then I can do something—”

Trevor: Can do something—

Blaise: “Because I can advocate or I can vote a certain way,” then maybe. But I think that in today’s day and age, people feel so disenfranchised and feel so hopeless and despairing, you know ...

Trevor: But I did that for Standing Rock. And maybe it’s because there’s a cultural identification there.

Blaise: There you go.

Trevor: But I looked at that situation, and I said, “I have to go there.” And I started a Kickstarter, and when I got there, there was barely any time to make a documentary, because you know what? So much work had to be done.

Blaise: Right.

Trevor: And it was a different situation ... I mean, literally right when I arrived somebody was like, “Hey, you, come over here, we need help with this tent.”

Blaise: Right, right, right.

Trevor: There was so much work that there was barely any time to film. And I couldn’t say, “Yeah, I know it’s going to be minus 20 degrees tonight, but I can’t help you with your tent. I got to make my documentary.”

Blaise: Right. Right. Right, right, right.

Trevor: So I went there because of the ... That’s a really, really good question. There is something we could do in any situation. Why don’t we? I don’t know.

Blaise: Well, and I think it’s because we have time and time again, if you think about the banking crisis and the Enrons of this world ... I mean, how many of those bankers who ... did all sorts of things with mortgages and really screwed a lot of people, how many of them are in prison today?

Trevor: Right.

Blaise: Because if you feel that by having a certain vote, and by advocating ... I have a dear friend who’s got a trans son, who’s been victim to a tremendous amount of ... Not himself, but just in terms of when we see what happens to people who are transgender, in terms of a lot of the laws and those kinds of things, that when there was questions being passed in terms of legal rights, because I’d seen an impact, I felt like I’m going to fight for this. And I’m going to go out and advocate for it. And then when that advocacy led to changes, it felt empowering. But you sort of think, okay, I’m going to fight for this one thing, but all you see is much more of the same, there can be quite a lot of despair.

Trevor: Like myself with Standing Rock, identifying something and seeing that I need to have action, there are teens that if these increased suicide rates are indeed directly related to the show, then people, there are people, those that are killing themselves, they’re not identifying with the protagonist. The protagonist is the young male. They’re identifying with—

Blaise: Well, in that case it was the young ... You mean, in the first show it was the young female.

Trevor: No, no, no. I think the protagonist is the young male, because he’s the one listening to the tapes—

Blaise: I’ve got it. I see what you mean.

Trevor: And going around. It’s not ... But he’s the protagonist.

Blaise: Got it.

Trevor: But they’re not identifying with him. They’re identifying with her.

Blaise: Right. Okay. I see what you mean.

Trevor: Who we’re hearing just in tapes. Or what’s really, from a production point of view, narration.

Blaise: Right. Right.

Trevor: So they’re identifying with her. They’re identifying with her action. Actually, they’re not identifying with her action, they’re seeing the action that she took, and is like, well, that’s exactly how I feel. If that’s what she did, should I do that? Or is it what we talked about last week in the pre-interview is that 13 Reasons Why, is it their romanticizing of suicide that goes all the way back to The Bard? Is it ... Suicide, and the romantic portrayal of suicide has existed in fiction ... It’s a cornerstone of romantic fiction. I’m not talking love stories, I’m talking romantic, emotional, fiction.

Blaise: Right. Yeah. I think one of the research reports showed that there was a blip of something like 157, 160 more suicides in the month after 13 Reasons Why the first season aired than would’ve been expected given the trends.

But there was a couple of interesting things about why is it in that month? Why isn’t it in the month ... Did we see it a week thereafter? Two weeks thereafter? Okay, so what happened in that month? Now, a researcher couldn’t find any other explanation, but we’ve got to be careful in terms of causation and correlation.

We know that young women are more likely to make suicide attempts than young men. Much more likely. Overwhelmingly more likely. And that adolescent women’s suicides are at the highest rate that they’ve ever been measured. Young men are more likely to complete suicide than young women. And I think it’s an interesting finding.

There’s no question that okay, we know that a month after that there was this increase. But do we know anything about the causality, the links between the show and what ultimately happened? Maybe schools started to talk about it, and it had nothing to do with the show, it had to do with the fact the schools were talking about it. Why is it that more men were doing it when ... And maybe there’s something about the identification with the protagonist. On the other hand, it was a young woman who dies.

Do we know anything about the viewing habits of these particular young men? I mean, let’s hypothesize that everybody was an, I don’t know ... We can make up a story that they were all playing Fortnite, and then for a month after 13 Reasons Why everybody got pulled away from Fortnite, and they were all talking about the show, and the few that were left were all feeling isolated and alone and abandoned because everybody else had gone to talk about the show. So it was just a feeling of disconnection.

So it’s easy to get on the bandwagon of saying there’s a terrible show. You could also make a case ... Look, if it’s bringing adolescent suicide much more into the public eye, which it needs to be, increased awareness, then that’s a good thing.

But again, you take this position or take this position. Everyone is going to justify their point of view. And rather than getting into that black and white we were talking about, that polarity, is saying for people who are at risk, what are we going to do? For people who are completely unaware, because it showed ... We looked at a recent study where after the second season, people were much more empathic towards people who are suicidal, and much more willing to go and help people who are suicidal. Well, that’s a wonderful outcome.

And you could say maybe the first one did do a disservice, but that the second one helped with awareness. Are we having it both ways, you know?

Trevor: You know what’s so funny is that I posted something on social media saying, “I have to watch 13 Reasons Why for work. You guys know my tastes, how do you guys think I’m going to react to this?” And I got a lot of responses. And the response that I saw consistently was, “Loved season one, hated season two.”

Blaise: Oh, that’s funny. Yeah. That’s interesting.

Trevor: And you’re talking about ... And season two is the one with the empathy. The one ... Or I just assume isn’t as dour and dark as the first season. That’s really interesting.

Blaise: I mean, right.

Trevor: Or I just have weird friends.

Blaise: Exactly. Well that could also be.

Trevor: There’s that.

Blaise: But I think ... I mean, those kinds of things lead to dissatisfaction. You can’t please all of the people all of the time, right? So there’s going to be perspective. But I think that even that situation, you can’t please all the people all the time, that when we have a disagreement, if you say, “I’m pro-Trump,” or, “I’m anti-Trump,” then again, there’s an absolute polarization of saying, “I’m this or that.”

But then if you take one position and I take the other, then I say, “I can’t believe that you are this,” so I paint you with this one terrible brush of saying you are pro or you are anti my position. I don’t get curious about how you got there. I don’t get curious about the conditions that arose to your perspective. I don’t share mine with you. But I also automatically dismiss any other commonalities that we might have in common. That maybe that’s the only thing that we disagree with, and lots of others. We might like the same movies. We might like the same food. We might like a game of backgammon, going for a walk. All of those things are cool, but you have this different perspective, but I paint you just with this one brush.

Trevor: Right.

Blaise: So I think that leaning in, getting much more curious ... Now, if we’re completely polarized on absolutely everything then the likelihood that we’re going to be friends and have an agreement, okay. But you know, to just sort of say, I bet you then ... Educators might say, “Oh, season two is much better because it’s leading to empathy.” But not to get just simply stuck in those positions.

Trevor: I think we live ... And DBT helped me get out of this, for the most part. I’ve still got a long way to go. I’ve learned that I led a life a long time of drawing lines in the sand.

Blaise: Right.

Trevor: And I drew those lines in the sand to protect myself, not knowing that drawing a line in the sand also provokes the person who’s standing right across. It’s natural. Oh, I’m drawing a line in the sand. It’s a provocation. I’m seeing that everywhere. There’s lines in the sand everywhere.

Blaise: Absolutely. I think we’ve been pushed into that way of thinking, and I think we’ve got to be careful that it doesn’t become pervasive, and that it kind of—

Trevor: I think it’s too late for that—

Blaise: Seeps ... Well, but I think at the individual level is to say ... The fact that maybe the current political climate is polarizing me, am I doing that in my relationships with the people I love? Am I doing it at work with the people I care about? Am I doing it at work in psychotherapy? Am I allowing that kind of divisiveness to seep into my day-to-day operations? And I think that that’s where we have to be. Because I think that we can become radicalized across the board, and then not take positions contrary to ours and see the wisdom in them. Which is core to DBT is finding the wisdom in the position of the other person.

Trevor: So ... yeah. My criticisms of 13 Reasons Why are merely of the show, but I’m glad it exists. And I will take a show that I find is not very well told, that sparks a conversation. I’ll welcome anything that provokes a debate regardless of how it approaches it.

Blaise: Okay. But then if we think about that debate is can we approach that debate with ... Open your heart and open your mind before you open your mouth.

Trevor: Yeah. Yeah.

Blaise: So it’s—

Trevor: And I’m the worst. I’m the worst. That is something that I’ve had to work on my whole life. But yes, that’s a great question.

Blaise: And just you say, “Look, I’ve come to a conclusion, but you know what? I am willing to hear new information. To understand a perspective. To be able to recognize and to validate that perspective.” And if you’re willing to go down that journey with me ... I don’t know, I think, in the second season for example, there was a warning that was put, or an advisory that was put saying, “If anybody’s suicidal, please call this number.” So okay, but maybe there are those sorts of changes, because that means that someone is listening to someone. And that we can have a different point ...

I might still decide that I disagree with you, but I can also accept that you’ve got a point of view that is shaped by your genetics, by your biology, by your experiences, by your development, by your context, by all of these sorts of things to get you to this point. I can still ... And I know that this is a very, very, very provocative word, but I can still love you as a human being who is struggling in the way that you are, without having to agree with everything that you do. And without having to compromise my relationship, whether it’s professional, filial, romantic, whatever it is with that other person, and still deeply care.

Because polarization is disconnection. We get so extremely apart that we ... And that we know that isolation and disconnection are the things that kill.

Trevor: That’s a really good point. I was in a men’s group, not here, somewhere else. But I was in a men’s group where there were members of the group that had committed terrible crimes. People were hurt. People were physically hurt at their hands. When you’re in group therapy with somebody for years, I mean, I’m not talking a week. We were in this group for years. I think I was in it for three years. Any manipulations that are going on, you’ll see the cracks in it. I felt after three years we really got to know the real people, who we are.

I don’t excuse what they did at all. But I totally understood how they got there. I totally understood. And I think people are afraid of empathy. People are afraid that empathy will lead to sympathy, which will lead to, “Hey, let’s welcome all the bad people in here.” And no, that’s not it at all. All it is is you’re just saying, “What you did was terrible. But what happened to you was terrible. And you were led by example. And I see why you did what you did.”

Blaise: Yeah. I mean, I think that we forget that everything is caused. And people often say, “Well, what’s the root cause?” But I said, “But there is no answer to that question, because the root cause has causes.” You say, “Well, there was an accident, and that was the root cause.” I said, “But that”—

Trevor: That’s amazing. The root cause has causes.

Blaise: Well, because okay—

Trevor: That’s amazing.

Blaise: Because okay, that ... You were in an accident so now you’ve got trauma. Okay, but the conditions on the road that somebody was texting and crashed into you. Well, why were they texting? Well, because somebody was in the hospital, and they wanted to know and then they were distracted. Well, why were they in the hospital? Well, because ...

So all of the causes, you try to get to the root cause. I often say, “You want to get to the root cause? Blame the Big Bang.” That’s the ultimate root cause, because that led to a sequence of events that led to this present moment. But we get so stuck in saying, “There it is.” It’s true that that’s how it impacted you, but that was influenced by all the other causes that were there at the time.

So I think that rather than trying to find blame about anything or anyone, which keeps us stuck and attached to a sense of injustice, is that peace is in letting go of that and saying, “What are the conditions now?” Because we spend our lives blaming the past, but then we never live, because we’re not in the present moment.

Trevor: Absolutely. That’s one of my biggest problems, constantly living in the past. I’m never in the present.

Blaise: Yeah. And holding onto what? As if we can change it by replaying it over and over and over again.

Trevor: So much guilt, shame, regret, all related to things that I can’t do anything about. So much.

Blaise: I gave up on regret, and I now have a sense of remorse much more being ... Remorse, as I’m defining it, as saying you know, given another opportunity I would do it differently. I apologize for having caused some harm. But I think regret is living in it. And ruminating in it. And it’s hitting the replay button. But it presupposes that you had the information then that you have now.

Trevor: That is so funny, because I still have a few lines in the sand that I hold on to. And one of them is anybody that says, “I have no regrets in my life,” is somebody that I want nothing to do with. And I’ve never come across a situation until right now that questioned that thought process. That is the first time that’s made me doubt standing by that rule. I have so much regret. I have so much regret. Related to innocuous things that don’t mean anything. And so much shame and guilt built around them.

Blaise: Yeah.

Trevor: And to hear that, I want to thank you, because that was just the challenge that I needed to hear. I mean, I don’t know if you ... I’m crying right now.

Blaise: I can see, yeah.

Trevor: This ... I have never heard anybody put it like that before. And that was exactly what I needed to hear. That I hold on to these regrets like badges of honor, and all that means is that I’m just still stuck in the past. Thank you.

Blaise: Yeah. I mean, you’re really welcome. But I also think that we make absolutely perfect decisions with imperfect information at the time that you did whatever it was that you did. And maybe you would say, “This is kind of foolish,” but it’s sort of interesting too. Because if the outcome is bad, we call it impulsive. If the outcome is good, we call it spontaneous.

Trevor: Yeah. That’s so true.

Blaise: We make a determination based on outcomes—

Trevor: Right.

Blaise: Not on the process at that moment. Because you could say, “Well, this is a little bit risky, I’m going to do this sort of thing.” But we also look back, bringing all this information that we have today, as if we had it then. And then we blame that child, that person, saying, “You should’ve known better.” Well, that’s because I have information now that changes it.

And it’s not like, oh, I’m waking up this morning, my life’s going pretty well, I’m going to fuck it up. No one does that that I know. I mean, maybe a few people do that, but most just want to get along. Most of us just want to have ... And yes, some of us do riskier things than others.

Trevor: I’ve been in that place where you’ve talked ... I’ve woken up saying, “You know what, I’m going to ruin things today.” But that was also a sign that you need to go talk to your doctor immediately.

Blaise: Right. Right. Yeah.

Trevor: And other people out there that are listening to that, trust me, that is a sign. When you wake up saying, “I am going to compromise my life today,” you need to talk to someone.

Blaise: Right.

Trevor: Because you don’t need that. You really don’t need it.

Blaise: But I actually want to push you a little bit further on it.

Trevor: Please do.

Blaise: Because you wake up in that morning, and you say, “I’m going to ruin things,” okay?

Trevor: Every morning, first thing, this is true. Every morning ... Waking up for me is a three-hour process. The first couple hours is me trying to convince myself just to live and get up and get in the morning.

Blaise: Right.

Trevor: And then I go through this. How am I going to go about my life today? Am I going to actually try and support myself? Or am I going to say, “Screw it,” and just do a bunch of reckless things and ruin my life?

Blaise: Okay, but if you think about your intention—

Trevor: Yes.

Blaise: And your purpose in that moment—

Trevor: Sure.

Blaise: When you say, “I’m going to do some reckless things, and just ruin my life.” Okay, what’s your intention and your purpose in that moment for those things? So let’s just take ... And again, you’d have to think about an example, and maybe not one that’s ultra-revealing, but let’s just think about something that you might say ... Like what?

Trevor: Oh, no, I can give you one right now. I smoke a lot of medical marijuana. I smoke a lot. And it’s often where I’m like, I’ve got bills to pay, I’ve got things to do, I have got things to get done in order for my life to move forward successfully. But instead I’m just going to sit home and smoke weed all day.

Blaise: Okay, and when you do that, what’s the effect of that?

Trevor: Oh, I feel terrible.

Blaise: Immediately?

Trevor: No, later. What it—

Blaise: You see, that’s my point. My point is that in that moment, you want to avoid, you want to escape, and you find that way in that moment.

Trevor: Yes.

Blaise: And all I’m saying is that if could be inside your head, I would understand the strong urge and the strong impulse to not want to be there. Now, of course the consequence of that is further down the road, but I’m just saying that in that moment, when you’re feeling that desperation ... Because you say, “Well, I’m going to go and ruin my life,” but what a horrible thought to have. So then what you do is you smoke some weed, and then you feel, “Oh, okay, I feel a bit better now.”

Trevor: Yep.

Blaise: It doesn’t last very long.

Trevor: Right.

Blaise: But I’m just saying that it ... It’s not. Because if you could do something else ... But it takes an effort. And I’m just saying from a DBT perspective, at that moment you’re doing the best you can. Now yes, you can do better, because that’s the other side of the dialectic, and you’ve got to push yourself harder, and you’ve got to be asking for help. But if I don’t accept you in that moment, struggling in that way, and just simply judge, “Oh look at that stoner ...” Rather than saying, “This is a human being who’s suffering. Who cannot face that. And has found an easier way out ...”

Trevor: And that’s all it is is an easier way out.

Blaise: At that moment.

Trevor: Yep.

Blaise: Until you say, “Okay, every day I’m going to wake up and I’m going to call my coach, I’m going to do something different. I’m going to move the weed to the other side of the state so that it takes an effort to actually go there. So I’m going to start making ... “If you don’t want to ... If you want to live the life you want to live, you’ve got to give up doing the things in the life that you don’t want.

Trevor: Right.

Blaise: Okay, but rather than just getting into a judgment thing is just to say I can accept you and love you in that moment, under those circumstances, and have extra expectation for you as you have of yourself. So that you can get there. But otherwise you’re going to say, “Well, why did I smoke five weeks ago and spend so much time smoking?” Well, okay. I mean, what’s the answer? And how does it help, even if you understand it? How do you do it differently today? Right now?

Trevor: Is there anything you want to add before we wrap up?

Blaise: I think you’re doing exactly the kind of work that we need.

Trevor: Thank you.

Blaise: And I appreciate it.

Trevor: I really appreciate it, Blaise.

Well, what did you think of that? I kind of wish that one went a little longer. I felt we only scratched the surface. It also was a struggle for me because Blaise specializes in DBT. DBT is a form of therapy that I’ve been involved with for many years, and you know ... I hope you guys can excuse me and my going down the DBT lane with him. I had a lot of questions.

Regarding 13 Reasons Why, I hope ... For those people that have enjoyed it, I hope I didn’t offend anybody by my harshness of it. I don’t think ... That might be the first time that I’ve really talked about shows or movies in that kind of detail. And when I talk about film, I don’t talk about whether ... so much what I liked and what I didn’t like, I really get into the nitty-gritty sometimes about the directing, and things like staging. Staging’s really important to me. The relations of the way characters and objects move within the composition of the frame, as it relates to the movement or non-movement of the camera. Spielberg was absolutely superb at staging. And those are things that I look at. And the best shows and the best movies are the things that make me forget that stuff.

But I do want to finish 13 Reasons Why. Again, I don’t think it’s particularly strong work, but I do have to admit at the end of every episode, I want to know what happens. Ultimately, I think that’s what any show and movie, or movie franchise, wants is to hook you into the next installment. And 13 Reasons Why definitely did that. So hopefully I get back to that soon. Right now I’m watching Fleabag on Amazon, and it’s incredible. Is anybody else watching that show? I think it’s amazing.

Anyways, hope you enjoyed it, and we’ll see you in two weeks. Two weeks. Thank you for listening to Mindful Things, the official podcast of McLean Hospital. Please subscribe to us and rate us on iTunes, or wherever you listen to podcasts.

And don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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