As a clinician and pioneer in suicide prevention research, Jill Harkavy-Friedman lends an ear to some of the darkest thoughts and feelings to grace the human conscience. After four decades of listening, she approaches each new story of internal turmoil and pain with a sense of hope – “pragmatic optimism,” she says.
“I feel each one physically in my heart,” says Harkavy-Friedman, a 2022 AAAS Fellow. “I am sad that we couldn’t save that person, but I believe we will be able to save people – and that we are.”
Today, Harkavy-Friedman leads the American Foundation for Suicide Prevention’s (AFSP) research and grants program, working with more than 200 scientific advisors to bring this research to the forefront, providing education opportunities for researchers and sharing research findings with the public. Awareness of suicide as a public health problem has evolved since Harkavy-Friedman was a young Ph.D. student in clinical psychology at the University of Florida. In that era, discussing suicide – especially among children – proved taboo.
In 1984, Harkavy-Friedman joined Montefiore Medical Center/Albert Einstein College of Medicine as an assistant professor where she established the Adolescent Depression and Suicide Program.
“I had to take a lot of pushback for using ‘suicide’ in the title,” she says. “This was 1985. People believed that kids don’t kill themselves, which was absolutely not true.”
A year later, she performed one of the first suicide studies in a high school, surveying a general student population about suicidal ideation and behavior. The results, published in the New England Journal of Medicine, found that a shocking 8.9 percent of students reported attempts to end their own lives – a rate that held constant in repeated studies over several years.
“This was big news,” Harkavy-Friedman recalls. “People were shocked that kids not only thought about it but had also planned and even made suicide attempts.”
At the time, she says, society also subscribed to the idea that suicide couldn’t be prevented.
“People thought, if someone wants to kill themselves, they just will,” she says. “That’s just not true.”
Harkavy-Friedman currently works closely with cross functional teams within AFSP to dispel this myth, developing programs and messaging to disseminate best practices in suicide prevention. AFSP’s Project 2025 focuses on four key areas – firearms, healthcare systems, emergency departments, and corrections systems – as opportunities for intervention. For example, population-level methods of prevention might include barriers on bridges or secure storage for implements of self-harm when someone is at high risk. Prevention can also occur on a personal level with an individual who is struggling with suicidal thoughts – even people with subtle signs that may be difficult to identify.
“When someone is in that suicidal state, that person is not their usual self,” Harkavy-Friedman says. “Their brain is desperate and telling them nothing is going to change.”
A person could rationalize suicide by viewing themselves as a burden. They might assume their family, whom they love, would be better off without them. To describe this process, Harkavy-Friedman coined the phrase “dysconnection” – a dysfunctional connection that follows a logical path but is semantically nonsensical.
“The hardest idea for people to get is that suicide is multifaceted. It’s never caused by one thing,” she says. “As we learn about the individual aspects and contributors, we need to be integrating on a personal level.”
Because of these nuances, suicide touches multiple fields of study. Harkavy-Friedman prides herself on building a research community of diverse expertise, from genetics to social and biological sciences. AFSP also awards grants in artificial intelligence and engineering fields developing apps to measure physiological indicators of risk.
“AAAS is a wonderful platform because suicide cuts across all areas of science,” she adds. “We need all these researchers in all these areas to come together to really understand suicide so we can develop interventions to save lives.”
Despite increased public awareness since early in her career, there’s still more work to be done. According to the Centers for Disease Control and Prevention, suicide rates increased 36 percent between 2000 and 2018. Harkavy-Friedman has always been interested in statistics such as this one. After joining the faculty at Columbia University in 1989, she taught research design and methodology to the school’s psychiatry fellows. She follows datasets, measuring suicide rates since the 1800s.
“It’s not as high as it was in the 1940s, but it is going up,” she says, adding that disparities in reporting for various racial and ethnic groups could be a factor.
In addition to her research, Harkavy-Friedman still maintains a clinical practice in Manhattan. She started at AFSP at age 55, having slowed some of her early career work for periods of time to raise her two children. Now a grandmother, she tries to mentor female colleagues juggling the roles of mother, researcher and clinician. Years ago, she was told she couldn’t have all three.
“I was okay with my career taking a bit longer. My family has always been my priority,” she says. “We only get one life … as far as I know. I’m living like I only get one life, and it can’t all be work.”