LULU MILLER: Hey, just a note that today's episode does contain discussions of suicide. Please listen with care.

[RADIOLAB INTRO]

[phone rings]

LULU: All right, we are gonna start with a phone call.

DONOVAN MCBRIDE: Hello?

SIMON ADLER: Hey, is this Donovan?

DONOVAN MCBRIDE: This is.

SIMON: Hey Donovan. Simon here. How are you?

DONOVAN MCBRIDE: I'm good. How are you?

SIMON: I'm all right.

LULU: And producer Simon Adler.

SIMON: You're back at school today, right? Do I have that—am I remembering correctly?

DONOVAN MCBRIDE: Yeah, today's the first day back, although we're not back in person. They moved everything online for today because of the temperatures.

SIMON: Yeah, so a little while back, I gave this guy Donovan a call.

DONOVAN MCBRIDE: Donovan McBride, and I'm a law student in Chicago, Illinois.

SIMON: On a day the weather was just awful.

DONOVAN MCBRIDE: It's somewhere around negative 30 outside.

SIMON: Oh, Jesus!

DONOVAN MCBRIDE: Yeah, I know. Some of the trains were breaking down because of how cold it was.

SIMON: Lulu, you can attest to that.

LULU: I can. Schools were canceled for cold alone. Yeah. Yeah.

SIMON: Okay, so I called him on a very cold and dark day to talk about a pretty dark moment in his life.

DONOVAN MCBRIDE: Yeah, so it would have been the summer of 2020.

SIMON: Okay.

DONOVAN MCBRIDE: I had graduated college during the pandemic, so I spent the last semester of college online for the most of it. And I moved to Chicago for a job, and I was also working that job virtually. And it was awful.

SIMON: What—what were you doing?

DONOVAN MCBRIDE: So I was a project assistant at a law firm, which basically means if 1,000 documents need to be renamed, you do that. If you need to call the same hospital every day and argue with someone to get medical records pulled, you do that. You know, and things like that.

SIMON: Not really the life after college he'd imagined.

LULU: Hmm.

LATIF NASSER: Right.

SIMON: And then, you know, on top of that, this is the summer of 2020. So COVID ...

LULU: ... is full-swing.

SIMON: COVID's full-swing.

DONOVAN MCBRIDE: And every day just kind of felt shut in, boxed out, hopeless, you know, depending on the day. And so, you know, there was a despondency lurking until probably August of 2020. And I had a series of a couple days where I barely could move from bed. You know, I was feeling very, like, physically heavy. Like, I couldn't move. Like, I felt very far away from people, physically but then also emotionally. And all my thoughts were centered on, like, the rest of my existence is gonna be this boring little job while the world falls apart around me. It was what I now know was basically a major depressive episode. And, you know, certainly in the moment, I felt like—like, it can't keep being like this.

SIMON: To the point, he says, that one—one evening ...

DONOVAN MCBRIDE: I felt quite honestly I think closer to death than ever before. And there was kind of a switch that flipped where I was like, "Either tomorrow I'm getting out of bed and I'm gonna find a way to be part of the world again, or I'm not. Like, this is the point. Like, this is the moment."

LULU: Whoa.

SIMON: Yeah. And he says that at that moment he remembers thinking ...

DONOVAN MCBRIDE: "Is there someone—is there someone that's basically required to talk to me right now?"

SIMON: Like, "I think I need help, but I don't know. I don't want to bother my family or scare my friends."

DONOVAN MCBRIDE: And I realized that there was someone technically who would be required to talk to me, which is, you know, the 988 number.

SIMON: 988 is the federal government's response to the suicide crisis in the United States. It's basically 911 but for mental health emergencies.

LATIF: That's great.

SIMON: It is great.

LULU: I didn't know it was federal government.

SIMON: Yeah. They've had a suicide crisis phone number for 15 years, 20 years, maybe?

LATIF: Wow, I'm really glad that that exists.

LULU: Yeah!

SIMON: It's awesome. It's amazing that they do this. And so, you know, Donovan, he picks up his phone ...

DONOVAN MCBRIDE: I'm in my bed crying at that point.

[dialing]

DONOVAN MCBRIDE: And I call ...

[phone rings]

SIMON: And lying there living through possibly the worst moment of his life, this is what he hears.

[ARCHIVE CLIP, automated voice: You've reached the 988 suicide and crisis lifeline. We are here to help. Por español, oprime el número dos. Please remain on the line while we route your call to a lifeline crisis counselor. Your call may be monitored and recorded for quality assurance purposes.]

[ARCHIVE CLIP: [jazzy music]]

[ARCHIVE CLIP, automated voice: Your call is important to us. Please continue to hold. If you feel like you are about to act on thoughts of suicide now, please contact 911 for emergency help. For tools to help cope with emotional distress, please visit 988lifeline.org or vibrant.org/safespace. Thank you for your patience.]

LULU: No!

LATIF: No!

LULU: No!

DONOVAN MCBRIDE: It was truly, truly a wild moment. Like, I'm attempting to confront one of the biggest personal challenges I've ever confronted. And, like, it's just—I just feel I'm, like, in the waiting room, you know?

SIMON: A waiting room with a robot voice and some snazzy jazz music.

DONOVAN MCBRIDE: Which in retrospect is objectively hilarious.

LATIF: [laughs]

LULU: [laughs]

LULU: No! That is ...

LATIF: That's ridiculous!

LULU: Yeah.

LATIF: That's, like, maddening!

LULU: It's like painfully tone deaf.

SIMON: It's a Monty Python sketch.

LULU: [laughs] I know. That's offensive!

SIMON: Yes, but Donovan, he did stay on the line.

LULU: Okay.

SIMON: Eventually got connected.

DONOVAN MCBRIDE: Yeah, I remember she picked up the line, and kind of just asked, "Well, what brings you here? Like, what do you want to talk about?" And I don't know, it was very, very comforting.

LULU: Oh, good! That's great.

SIMON: Totally. But, like, Donovan, you know, he's not everybody. Something like three million people call 988 every year and hear this.

[ARCHIVE CLIP: [jazzy music]]

SIMON: And 13 percent of them, almost 400,000 people, they just hang up.

LULU: Yeah. Almost half a million not getting help.

SIMON: Yeah, they're left feeling alone right in the moment they need help most.

LULU: Yeah. That's the kind of feeling that could compound, you know?

SIMON: Yeah.

LULU: It's such a dangerous moment.

STEPHANIE GROSSER: If you've been on hold—I'm someone who doesn't like those automatic messages, and I'm the person yelling, like ...

SIMON: Does anyone?

STEPHANIE GROSSER: "Operator! Operator! Operator!" into the phone ...

SIMON: Exactly!

STEPHANIE GROSSER: ... whenever I can.

SIMON: So this is Stephanie Grosser.

STEPHANIE GROSSER: Technology lead for 988 at SAMHSA within the Health and Human Services Department.

SIMON: And what does that mean, a technology lead? And just a heads-up, I will be interrupting you a good chunk, but that's not because you're doing anything wrong.

STEPHANIE GROSSER: Okay.

SIMON: It's just the way we sort of do it.

STEPHANIE GROSSER: Okay. Great.

SIMON: So yeah, what is the technology lead?

STEPHANIE GROSSER: Technology lead looks at improving how the government is interacting with the public. In the case of 988, that means what does the experience look like for people calling 988?

SIMON: Hmm.

STEPHANIE GROSSER: And so how can we do better, right? We don't want a 90 percent answer rate. Obviously, we want to improve access to care.

SIMON: And she says, you know, the easiest way to do this would be to just hire more people to answer the phones, but ...

STEPHANIE GROSSER: Funding, right?

SIMON: Funding for mental health is hard to get, and so they're stuck putting people on hold in the worst possible moment. However, right around two years ago, Stephanie and a couple of her colleagues, they started wondering ...

STEPHANIE GROSSER: If we could actually improve the experience, would that help people hold longer?

SIMON: Like, could they get more people to sit through being on hold simply by changing the automated message and replacing the hold music with a new song?

STEPHANIE GROSSER: That's right.

SIMON: Or said another way, could they swap in a song and literally save lives?

LATIF: Oh, man!

SIMON: It's like the highest-stakes hold music situation in the universe.

STEPHANIE GROSSER: Yeah, that's a great way to frame it.

LULU: All right, so this is Radiolab. I'm Lulu Miller.

LATIF: I'm Latif Nasser.

LULU: And today, the search for this holy grail of hold music, a song that could accomplish the impossible and get people to stay right when they're thinking of leaving.

SIMON: But to start ...

SIMON: Not to be glib here, but whose idea was it to make suicidal people sit on hold?

GEORGE COLT: [laughs]

SIMON: ... the story of how we got here.

GEORGE COLT: Well, you could—you could take it way, way back, but I think really it began with a guy named Ed Shneidman.

SIMON: Okay.

SIMON: That's author and historian George Colt.

GEORGE COLT: I spent quite a bit of time with Ed researching my book. [laughs] And he sort of ...

SIMON: [laughs] Wait, why laugh? Why laugh here? You have to explain that laughter.

GEORGE COLT: Well, he's just quite a character. He was this small, compact bull in a china shop, but a very, very intelligent bull.

SIMON: Okay.

GEORGE COLT: Anyway, the way he got things kicked off was in 1949, he was a psychologist working in the Los Angeles Veterans Center.

SIMON: He was a psych PhD and a World War II veteran actually studying schizophrenia.

GEORGE COLT: And he was asked by his boss to write letters of condolence to two veterans who had killed themselves. And so he went to the coroner's office to find out more about these two people.

SIMON: Coroner said their records should be down in the basement.

GEORGE COLT: And in that dusty basement room he found suicide notes.

SIMON: And not just in the folders of the guys he was there to learn about.

GEORGE COLT: No. Ed liked to push things to the limit. And so he ended up looking through almost every folder in the room, and what he essentially found was 721 suicide notes. So all of these folders had suicide notes in them.

SIMON: Now Ed, he hardly knew anything about suicide. It wasn't something that psychologists really studied.

GEORGE COLT: "Suicide" was not even a word that people wished to utter in public. There were so many different euphemisms for it—to make away with oneself, to do away with oneself. The whole topic was so taboo that the general 'treatment'—and I use that word in quotes—was just to take away, you know, anything sharp and hope they wouldn't take their own lives.

SIMON: But Ed, being a young, ambitious research psychologist, he was suddenly intrigued.

GEORGE COLT: He realized that this was just a cache of research material. As he said to me, "I felt like a Texas millionaire coming home and stumbling into a pool of oil."

[ARCHIVE CLIP, Edwin Shneidman: "I don't know why I'm bothering to write this. I'm leaving out so much."]

SIMON: This is Ed years later, reading through one such note in an oral history.

[ARCHIVE CLIP, Edwin Shneidman: "It's probable I won't be able to explain myself, even if I took the time to write reams of material. It's just that it's so difficult to transmit information to get through others' preconceived notions.]

SIMON: And in this note and others, he noticed the authors trying and struggling to articulate why they were about to kill themselves.

[ARCHIVE CLIP, Edwin Shneidman: "No, I'm not going to try. To hell with it. If I want to commit suicide it's my privilege, dammit."]

SIMON: And he thought maybe that by reading enough of these notes, he could decipher why people killed themselves and help stop others in the process.

[ARCHIVE CLIP, Edwin Shneidman: Suicide prevention. I mean, there was no question. I wanted to be a little ahead of the time and push the issue.]

SIMON: But to do that, he knew he was gonna need help.

GEORGE COLT: And so he got in touch with a friend of his named Norman Farberow, who was also a Veterans Administration psychologist.

SIMON: And sort of the yin to his yang. I mean, if Ed was a little tightly-wound ball of energy ...

GEORGE COLT: Farberow was tall, slim, reserved, quiet, dignified.

SIMON: And while Shneidman was sort of the big idea guy ...

GEORGE COLT: Farberow was wonderful at assembling data and doing research.

SIMON: And quickly Farberow was like, "These suicide notes, they are fascinating, but they're sort of all over the place."

GEORGE COLT: One of the notes, for instance, was, "Dear Mary, I hate you. Love, George."

SIMON: I mean, there just wasn't that much to be gleaned about why these folks took their own lives. And so Farberow said, "We're gonna need more data."

GEORGE COLT: And so they began this incredibly vast examination. They combed through records at psychiatric hospitals, diaries, therapy records. Sorted through all of this stuff, and then began to make some conclusions. And they really did find some of the concepts that still hold true today. For instance, suicidal people are often ambivalent. There's a part of them that wishes to kill themselves, perhaps, and a part of them that wishes to stay alive. And if you can get them through what's called a suicidal crisis ...

SIMON: Essentially, an overwhelming but oftimes brief flash where the desire to die overtakes the desire to live.

GEORGE COLT: If you can get them through the crisis, they can find other alternatives to suicide.

SIMON: And they discovered the best way to do that totally by accident.

GEORGE COLT: What happened was that as they were gathering all this data, much of it from hospitals, you know, nurses would say, "Gee, would you mind go talking to this fellow over in, you know, room 102? He's suicidal, and we really don't know how to handle him." And so Shneidman and Farberow would say, "Well, we—okay."

SIMON: And sitting down with these people ...

GEORGE COLT: Shneidman and Farberow thought that they were just doing research, but they discovered that these suicidal people, just by having somebody to talk to, the part of them that wished to kill themselves was relieved.

SIMON: Listening. The very thing nobody was willing to do was the thing these folks needed.

GEORGE COLT: It was this simple notion of listening will help. And so Shneidman and Farberow said, "Goodness, we've gotta do something about this." So they got some money, they got a five-year grant.

SIMON: Brought on a third guy.

GEORGE COLT: A fellow named Robert Litman, director of the psychiatric unit at Cedars-Sinai Hospital. And on September 1, 1958, these three perhaps nutty psychologists opened the Los Angeles Suicide Prevention Center.

[ARCHIVE CLIP, Tony Allan: [singing] I wish you'd stick around. Stick around.]

SIMON: The very first of its kind, trying out this treatment of just listening to folks in their moment of crisis.

GEORGE COLT: With one phone line and a staff of five.

[ARCHIVE CLIP, Tony Allan: [singing] Around. I wish you'd stick around.]

SIMON: And it worked—or at least people were eager to talk to them. Especially as they advertised their phone number, more and more people began calling in, searching for a sympathetic ear. But I mean, these guys were based in LA, and it was all still pretty local to LA. Until, that is ...

[NEWS CLIP: One of the most famous stars in Hollywood history is dead at 36.]

GEORGE COLT: The Marilyn Monroe case.

[NEWS CLIP: Her housekeeper, Eunice Murray, noticed that Miss Monroe still had her bedroom light on at midnight. A physician, hurriedly summoned, broke the bedroom window, found the actress dead in bed, with an empty bottle of sleeping pills nearby.]

SIMON: August, 1962.

GEORGE COLT: The chief coroner asked Farberow and Litman to help him determine what caused Marilyn Monroe's death.

SIMON: And two weeks later ...

[ARCHIVE CLIP, reporters: Okay, you're up. Let's go, doc. Go ahead.]

SIMON: ... sitting in front of a bank of microphones, Shneidman, Farberow and the coroner, they held a press conference.

[ARCHIVE CLIP, Dr. Theodore Curphey: Ladies and gentlemen, now that the final toxicological report and that of the psychiatric consultants have been received and considered, it is my conclusion that the death of Marilyn Monroe was caused by a self-administered overdose of sedative drugs, and that the mode of death is probable suicide.]

SIMON: And that word ...

[ARCHIVE CLIP, Dr. Theodore Curphey: Suicide.]

SIMON: ... hit ...

[ARCHIVE CLIP, Dr. Theodore Curphey: Suicide.]

SIMON: ... like a lightning bolt.

[ARCHIVE CLIP, Dr. Theodore Curphey: Suicide.]

GEORGE COLT: You could say that it got the nation's attention.

SIMON: The New York Times, the New York Mirror, the Daily Mirror all did stories on her death.

[NEWS CLIP: She has unwittingly played the greatest role of her career in focusing attention on the gravity of suicide.]

SIMON: And they named Shneidman, Farberow, Litman and the work they were doing.

[NEWS CLIP: Attempting to help those who contemplate self-destruction.]

SIMON: And as their names bounced around the country, their idea, that just listening to someone over the phone could save their life, it did too.

GEORGE COLT: There were actually movies about this. Dial Hotline and The Slender Thread ...

[ARCHIVE CLIP, The Slender Thread: I just want somebody to talk to.]

[ARCHIVE CLIP, The Slender Thread: Maybe I can suggest somebody for you to see.]

[ARCHIVE CLIP, The Slender Thread: No!]

GEORGE COLT: ... dramatized volunteering at prevention centers.

[ARCHIVE CLIP, The Slender Thread: Geez.]

GEORGE COLT: People were excited at the notion that all I need to do is open up a phone line, listen, and I could save lives." And so by 1969, there were more than a hundred prevention centers with different names: We Care, Dial-A-Friend, Learn Baby Learn, Lifeline, Help, Rescue Inc.

SIMON: I mean, this network of independent and amateur call centers.

GEORGE COLT: It grew like hotcakes—or perhaps more like a spider's web, or more like a—I don't know, what's a good phone line ...

SIMON: Uh, yeah.

GEORGE COLT: It went viral. And what happened there, actually, was not necessarily a good thing, because you have to understand that at the LASPC, the Los Angeles Suicide Prevention Center, Shneidman and Farberow and Litman prided themselves on their professionalism and their very carefully trained volunteers.

SIMON: But at a lot of these other, newer centers, that was just not the case.

GEORGE COLT: Many of them, they'd open up without really any training, and I think things got a little bit, dare I say, out of control.

[ARCHIVE CLIP, volunteer: We are here.]

SIMON: This is a recording from one of those centers. First voice you'll hear is the caller's. She's slurring her speech a little bit, clearly exasperated.

[ARCHIVE CLIP, caller: Now just a moment. I'll tell you right now, I intend to do something tonight ...]

[ARCHIVE CLIP, volunteer: Get out! Get a counselor!]

SIMON: And there, you hear the volunteer chiding her, saying ...

[ARCHIVE CLIP, volunteer: We can't help you like a fairy godmother.]

SIMON: "We can't be your fairy godmother."

[ARCHIVE CLIP, caller: Won't you listen to me?]

SIMON: Here's the caller again.

[ARCHIVE CLIP, caller: As far as I'm concerned, this is a bunch of baloney. You just give me further problems.]

SIMON: And again, the volunteer.

[ARCHIVE CLIP, volunteer: We want to help you. We want to help you help yourself. We cannot be there holding your hand.]

SIMON: "We can't be there holding your hand," she says.

[ARCHIVE CLIP, caller: You are joking. Let's forget it.]

[ARCHIVE CLIP, volunteer: Okay. But you get group counseling.]

[ARCHIVE CLIP, caller: Oh shit! You should see yourself!]

[ARCHIVE CLIP, Edwin Shneidman: I spent hours listening to those at home.]

SIMON: Again, Ed Shneidman.

[ARCHIVE CLIP, Edwin Shneidman: I had one reaction to them: I was absolutely dismayed. More than—I was flabbergasted. I was stunned. These are just horrendous examples of what not to do on the telephone. I felt, in part, impotent. I couldn't go into Alabama or Georgia and tell people what to do.]

SIMON: I mean, when he heard recordings like that one, he began to worry that these centers were actually doing more harm than good.

GEORGE COLT: So he tried desperately to get hold over these proliferating lines across the country, but there was no way to enforce the notion that you had to have standards.

SIMON: Which brings us back to today because in the years that followed, the federal government decides, like, "Okay, we gotta get our arms back around this. And the way we're gonna do that is by centralizing everything."

LATIF: Mmm.

SIMON: And basically what that has meant is a system where when someone calls 988, the suicide crisis hotline, the person who answers it is patient and is empathetic and well-trained and professional. But because there's not unlimited funding to train these people, to hire these people for mental health in this country, when you call, you first get this.

[ARCHIVE CLIP: [jazzy music]]

LULU: This is—this is oversight.

SIMON: Yes.

LULU: This is standardization.

SIMON: Yes. So how on Earth do you make this an experience someone thinking of ending their own life will sit through?

[ARCHIVE CLIP, automated voice: Thank you for continuing to hold. We apologize for the delay.]

LULU: We'll get to that after a short break.

LATIF: Hello again. I'm Latif Nasser.

LULU: And I'm Lulu Miller. This is Radiolab. Before the break, producer Simon Adler had just told us the story of how three professionals built and then lost control of a nationwide network of crisis hotlines, of suicide crisis hotlines, how the federal government swooped in and built its own network to restore order, and how the consequence of that safer standardized network is folks in crisis sitting on hold.

SIMON: Yeah, that's right. And so two years back, with an influx of cash, 988 brought in these two tech wizards to try to solve this problem.

MELISSA EGGLESTON: Yeah, so we both worked for the United States Digital Service, and I was at DSAC. And DSAC really likes to support SAMHSA.

SIMON: Jesus Christ, so many acronyms!

MELISSA EGGLESTON: I know!

SIMON: Also, DSAC is just not a very nice one. Like, SAMSHA sounds so much nicer than DSAC.

MELISSA EGGLESTON: I know. I mean ...

SIMON: This is Wizard number one, Melissa Eggleston.

MELISSA EGGLESTON: User, researcher and designer.

SIMON: And Wizard number two ...

STEPHANIE GROSSER: So from a technology perspective ...

SIMON: ... Stephanie Grosser, we met back at the top of the episode. And as Stephanie explained to me, they were able to use big data to tackle this big hold music problem.

STEPHANIE GROSSER: Because we're centralized, we have the ability to track a lot of information about the calls coming in and our answer rates across the country.

SIMON: I mean, they could actually see precisely when people were hanging up, and could talk to callers who had volunteered to give feedback.

STEPHANIE GROSSER: So for example, "This call may be monitored and recorded ..."

[ARCHIVE CLIP, automated voice: ... and recorded for quality assurance purposes.]

STEPHANIE GROSSER: There was a spike of hangups during that part. And talking to people with lived experience, they said, "You know, when we call 988, thinking about suicide, we need to hear affirmations, things like, 'We want to talk to you. Please stay on the line.'"

SIMON: And so with all this data, they started tweaking the script, going back and forth on different words, how many syllables were in different phrases. They hired someone to be the new voice of 988.

MELISSA EGGLESTON: This person, Jan ...

[ARCHIVE CLIP, Jan: Amazing isn't just a place you take yourself, it's where that place takes you.]

MELISSA EGGLESTON: ... who sounded a little bit like a yoga teacher.

SIMON: And happens to have been the voice of ...

[ARCHIVE CLIP, advertisement: EnjoyIllinois.com.]

SIMON: Illinois tourism.

MELISSA EGGLESTON: Yeah.

SIMON: And from there ...

MELISSA EGGLESTON: Everybody was very clear, like, this jazz music has gotta go. [laughs]

SIMON: ... it was time to tackle the hold music.

SIMON: Okay, so what the hell do you do next? Like, how do you set out to try to make this better?

MELISSA EGGLESTON: We worked to determine, like, what are the characteristics that this should reflect? And it's things like 'human' and 'hopeful' and 'calm' and 'reassuring' and 'warm.'

STEPHANIE GROSSER: But not too peppy. And so it was really like a fine line that we were trying to have between calming but also uplifting. And so we have a routing company, and they actually have a bank of music, and so we went to them to get between, like, 30 and 50 songs. And we had people independently listen and rank them, and we compared everyone's rankings to come up with a top four that we would bring to our public research.

LULU: Okay, what are the four options? And, like, can we hear each one briefly?

SIMON: Yes.

LULU: Perfect. Okay.

SIMON: Okay. Copy Dropbox link. Okay, it is in the—it is in the ...

LULU: Okay, lovely. Okay. Should we do number one?

LATIF: Hit it!

LULU: Okay.

[music plays]

LULU: [singing] I'm a Home Depot commercial for outdoor rugs. I am walking ...

LATIF: Outdoor rugs is pretty good.

LULU: Okay. Okay, so that's number one.

SIMON: Right. Okay, number two.

[music plays]

LATIF: It feels too generic somehow.

LULU: Yes. It's cold.

LATIF: Like, it's like, this feels like therapist office.

LULU: Yeah. But ...

LATIF: And maybe that's good? I don't know.

LULU: Okay. Three?

SIMON: Three.

[music plays]

LULU: Hmm. I'm not sure. I feel the cosmos. There's a searching darkness I don't mind in this one.

LATIF: This is so subjective.

LATIF: But it's—like, it's just so hard to know what'll feel right to someone at that moment.

SIMON: Yeah. This is one of the challenges.

LULU: Yeah.

SIMON: But last but not least, number four.

[music plays]

LULU: Oh fuck no, not this one.

LATIF: I don't mind it.

LULU: You don't mind that it's like a commercial for Wonder Bread's new brand of wheat Wonder Bread?

LATIF: [laughs]

LULU: Like, piano is offensive, it's just like tweedle-deedle-deedle, everything is fine!

SIMON: Well, those are your choices, so ...

LULU: Okay, what—out of those, what are you doing?

LATIF: I feel like I'm gonna make an unpopular choice. I think number one, maybe?

LULU: Oh, the home renovation—the Home Depot outdoor rugs?

LATIF: Yeah, I think so.

LULU: Too much—too many sunflowers. I feel assaulted and forced into being in a good mood by somebody who doesn't understand me.

LATIF: Okay, fair, fair, fair.

SIMON: Lulu, where do you fall?

LULU: I'm going three. I'm like, okay.

LATIF: Okay, wait, can you play three again, sorry, just for one second?

[music plays]

LATIF: That's fine.

LULU: There's like a little bit too much club encouragement for me to dance.

LATIF: Yeah.

LULU: But of all of them, it's the most neutral, which I appreciate.

SIMON: Well, okay. So what we just did right now is basically what Stephanie and Melissa set out to do.

STEPHANIE GROSSER: Literally we went to the National Mall in Washington, DC, and stopped people walking on the mall and ...

SIMON: Really?

STEPHANIE GROSSER: Yes. I put on my 988 t-shirt.

SIMON: Right.

STEPHANIE GROSSER: And we had granola bars to hand out.

SIMON: [laughs] Okay.

STEPHANIE GROSSER: And we had people listen live through our phones and vote on which one they liked the best. And so we did a little tally of what people voted on, and by and large everyone really agreed on the same music choice.

LULU: Okay, so yeah, what did they ...

SIMON: Both of you will be disappointed to know that ...

LULU: [gasps] Neither of us?

SIMON: Nope. Sorry.

STEPHANIE GROSSER: People really liked the inspirational piano music.

LULU: Oh, the Wonder Bread?

SIMON: With one massive caveat.

STEPHANIE GROSSER: We had certain limitations that we were working in.

SIMON: Okay.

STEPHANIE GROSSER: We're actually limited to—without going through an approvals process, we're limited to talk to nine people.

SIMON: Wait. Sorry, that's crazy. What? Nine people? What does that mean? What does that look like? You've got nine people, and those are the only nine people you can ask?

STEPHANIE GROSSER: Yeah. Yeah.

SIMON: Hmm.

LATIF: That's ridiculous!

LULU: [laughs] That's it? Like, the mental health of millions of people depends on these nine strangers on the mall?

SIMON: Yes. So thanks to the Paperwork Reduction Act of 1980, which was passed to minimize the amount of paperwork the government could ask you and I to fill out, if Stephanie and Melissa wanted to talk to more than nine people, they would have had to go through this months-long, potentially years-long process to get approval. However, you know who isn't bound by the Paperwork Reduction Act?

SIMON: Okay, one, two, three, four, five. One, two, three, four, five.

SIMON: Me.

SIMON: I'm gonna start talking to people.

SIMON: So I took a recorder out to New York's national mall, Times Square.

SIMON: Can I ask you a few questions?

SIMON: And just like Melissa and Stephanie, I asked ...

MELISSA EGGLESTON: "Hey, we're trying to improve our national suicide hotline. I'm wondering if you would be willing to listen to some hold music."

SIMON: ... "I'm wondering if you would be willing to listen to some hold music."

MAN: Sure.

MAN: Yo hablo español?

SIMON: Hablas español. Pues sí.

LULU: How many did you ask?

SIMON: 16.

LULU: Oh, wow!

LATIF: Doubled it.

LULU: You doubled their sample size. [laughs]

LATIF: Okay.

SIMON: Yeah. I'd hand them my phone.

SIMON: You can just hold this right next to your ear, and yeah, just tell me—tell me what your thoughts are as it goes.

SIMON: And first of all, my biggest takeaway was ...

MAN: I don't know. I don't like it.

WOMAN: That's depressing.

MAN: Just sounds kind of hard on the ears.

MAN: That sounds like some hotel lobby elevator music.

WOMAN: No.

WOMAN: No.

SIMON: People hated ...

WOMAN: No, I don't—I don't like any of them.

SIMON: ... all of them.

WOMAN: If I'm on hold, I want something that I like.

SIMON: But—and granted, these were just random people on the streets, but when I forced them to pick their favorite ...

MAN: Probably number four is the best one.

WOMAN: The fourth is the best of the four.

WOMAN: I liked that the best out of all of them.

MAN: The fourth one.

WOMAN: Number four is what I'm gonna decide on.

SIMON: I replicated their results. People preferred four.

LULU: Oh my God, I feel so ...

LATIF: What was the least?

LULU: ... shocked!

SIMON: People hated number one.

LATIF: Hated number one? Wow!

SIMON: Yeah.

LULU: I wonder how the samples—how the result would be influenced by people who have, like, struggled with suicidal thoughts, which I'm just only laughing because I'm trying to—like, I'm trying to be right, and I'm like, I think my opinion matters more than either of yours, as having publicly written about my struggle with suicidal thoughts. I think they should take my count. My opinion should matter more.

SIMON: Yeah, I—like, I think that's actually totally fair and right. And to the extent they were allowed to, they did take feedback from folks who have called 988 and lived through this experience. But I don't know. That's just one of, like, the huge challenges of this project. You can't ask somebody in the middle of a crisis how does this music make you feel?

LULU: No, but like, what I think is so painful about all of these options is, like, they are exactly—they are the same prob—they hold the same problem that the original jazzy hold music held, which is like, you can feel their muzak-ness, you can feel their corporateness.

LATIF: But the question is broad. Like, you can't go—you can't hit a broad thing with a specific thing that's gonna turn off half the people.

SIMON: Yeah, and you are—you are also ...

LULU: But I don't know. But going—yes, I agree something broad and, like, somewhat innocuous or ambiguous or neutral would be good. Like, I agree with that.

LATIF: Yeah.

LULU: These just all sound so manicured and soulless that that's, like, often—that distance, that, like, apartness from humanity is often part of what's going on. Like, just give something a little human.

SIMON: I will pass your criticism along.

LULU: Thank you.

LATIF: [laughs]

LULU: Please do. Okay.

SIMON: Anyhow, they did have one way to see how people who actually called in might react. After they narrowed it down, they cut the country in two and did a month-long national A-B test.

LULU: Oh, cool!

LATIF: Okay.

SIMON: Where half the callers would receive the old snazzy jazz experience ...

[ARCHIVE CLIP: [jazzy music]]

SIMON: ... and half would get the new one.

[ARCHIVE CLIP: [mellow piano music]]

[ARCHIVE CLIP, Jan: We are checking for a counselor who is available to talk. You'll hear music while we do this, and we'll give you an update in 30 seconds. You are not alone. We care and want to support you. Someone will be with you soon.]

SIMON: Okay. And are the results in yet?

STEPHANIE GROSSER: We are done. Yes. It was live for the country in the month of August.

SIMON: Okay.

STEPHANIE GROSSER: And so we had a four-week test.

SIMON: After all this, they managed to increase people staying on by 0.7 percent.

LATIF: Okay.

LULU: [sighs] Not great.

SIMON: Sure. But also, like, think about it again, we're just talking about a huge number of people here. So 0.7 percent ...

LULU: That's like how many people a year?

SIMON: So, like, 36-ish thousand people.

LULU: Oh, man. It's just like all that effort, all that time, but with those, in my opinion, doomed choices to begin with. I don't know. I just—I think they could've got a better result with better options.

SIMON: That's fair. But maybe it's helpful to keep in mind that despite how big of an effort this was and how modest of a change, like, each of those 36,000 people ...

[ARCHIVE CLIP: phone ringing.]

SIMON: ... is a person, whose life is hanging in the balance.

POROCHISTA KHAKPOUR: Hello?

SIMON: Hey, is this Porochista?

POROCHISTA KHAKPOUR: Yes. Hi, how are you?

SIMON: A person like Porochista Khakpour here.

SIMON: I'm good. How was your—did you get to have a long weekend?

POROCHISTA KHAKPOUR: It was kind of a crazy weekend because we're still unpacking in our apartment.

SIMON: Porochista is a writer here in New York City.

POROCHISTA KHAKPOUR: I always wanted to live in New York. I wanted to be a writer. And luckily, I was able to do that.

SIMON: Moved here when she was 18.

POROCHISTA KHAKPOUR: From California—the San Gabriel Valley specifically. And pretty much since then I've been mostly here.

SIMON: And the other constant in her life, she says, has unfortunately been mental health challenges.

POROCHISTA KHAKPOUR: Yeah, I go pretty in and out of severe depression ...

SIMON: Okay.

POROCHISTA KHAKPOUR: ... often. But I never felt a moment of suicidal ideation like I did on Christmas Eve this year.

SIMON: At the time, she and her boyfriend were months into trying to find a new apartment. Work was particularly stressful. And, you know, as a writer, she's got a bit of an online following, and was just getting an extra dose of shit from people on the internet.

POROCHISTA KHAKPOUR: About how this next book of mine, like, nobody cares. Like, just hateful stuff. So it was just like a perfect storm. Sorry if I'm getting a little emotional.

SIMON: No, you're fine.

POROCHISTA KHAKPOUR: It was a mess. And then I happened to see this tweet that said, "Hey friends, if you feel like you're in emotional danger tonight, please call 988." So I remember I was in bed. I had been crying for so many hours, and my boyfriend had just brought me, like, some takeout food. And I just called just to see what would happen, and there was just something from the beginning that made me feel really comfortable.

SIMON: By December, the new hold experience was the hold experience for everyone. And so ...

SIMON: I have to ask, like, do you remember the hold music?

POROCHISTA KHAKPOUR: Yeah. It's such an interesting question. I'm trying to think. Well, it was something somewhat pleasant. And I was just very surprised, because years before I called some sort of old-school suicide hotline, and I'd gotten off the phone pretty fast because I just—it just didn't feel right. But this call with 988 felt different than that. Everything from the music all the way to the person, it felt really natural. It didn't feel like a scripted government anything. And I guess that's why it worked.

LULU: Hmm.

SIMON: And it's like ...

LATIF: That was the best you could ask for.

SIMON: ... that's the dream.

LATIF: Yeah. Yeah.

SIMON: Like, not that the music's good, I guess, but that it's almost invisible.

LULU: Yeah.

POROCHISTA KHAKPOUR: It didn't fix everything. It wasn't like, "Okay, now you have no problems," but it kind of reset my brain. It made me feel like I could buy some more time before, you know, I make this horrific decision.

SIMON: But one more thing before we go. I gotta say, like, as great as it is that 988 got 36,000 more people to stay on the line, like, to your earlier point, Lulu, I do still feel like we could do better here.

LULU: Yes! Me too. I'm with you.

SIMON: Like, no shame to 988, to Melissa, to Stephanie.

LULU: True. Props to them. Fighting the fight from within.

SIMON: They were working within some crazy constraints like the Paperwork Reduction Act, like having to use music from a library of hold music. And so as I was finishing up reporting this, I started wondering, like, could I find somebody to make a song ...

[phone ringing]

SIMON: ... that would work even better?

SEAN CAREY: Hello.

SIMON: Hello, Sean. How are you?

SEAN CAREY: I'm well. How are you?

SIMON: I'm all right. Where—where am I speaking to you at?

SEAN CAREY: Uh, I'm at home in Eau Claire, Wisconsin.

SIMON: So I reached out to musician Sean Carey here because, well, he makes the antithesis of hold music.

[ARCHIVE CLIP, S. Carey: [singing] Daily, I still feel the silk sunshower.]

SIMON: Probably best known for being an original and current member of the band Bon Iver, but he makes his own just haunting, heartbreaking music, like this song, "Sunshower," under the name S. Carey.

[ARCHIVE CLIP, S. Carey: [singing] I don't know myself before I knew you.]

SEAN CAREY: I'm not trying to write sad music. I'm just trying to write, like ...

SIMON: [laughs] Beautiful music, I would guess.

SEAN CAREY: Yeah, that's definitely more the—more the vibe.

SIMON: And, you know, I told him the whole story about 988, and then I asked him, like, would you be willing to try writing something for this?

SIMON: Is that something you'd be interested in?

SEAN CAREY: I could definitely try that, yeah. Probably what I would do is I would experiment and really try to empathize with being on the other side of that line. You know, you want soothing, you want warmth, and so I guess I would think about human voice, maybe using that as an instrument. And white noise, like, you can play with it so it sounds like waves or sleeping on the beach or something. So I guess that's where I would—where I would start, and see what happens.

SIMON: A week later, I called him back up.

SEAN CAREY: It was definitely, like, one of the more challenging things I've ever done, I think. It was just hard to know what to do. I mean, when I actually got in there and was creating, just trying to create a hug. Like, just like, okay, what's gonna feel like a hug in audio form coming through a phone?

SIMON: He says in essence what he ended up going for was hold music that feels like it actually holds you.

SEAN CAREY: So I don't know. I mean, that was—that became more of the goal, but who knows? I think for some people they might despise it. [laughs] I don't know.

SIMON: [laughs]

SIMON: And here it is. It's called "You Are Not Alone." And Melissa, Stephanie, everyone at 988, if you're interested, be in touch.

[ARCHIVE CLIP, S. Carey: [instrumental music]]

LULU: Thank you, S. Carey. And thank you, Simon Adler.

LATIF: This episode was reported and produced by Simon Adler, and edited by Pat Walters. Fact-checking by Natalie Middleton.

LULU: If you are having thoughts of suicide, you can call or text 988 to be connected after only a brief hold to a living, breathing human. Or go to SpeakingofSuicide.com/resources for a list of additional resources. Special thanks this episode to Dr. Matt Wray at Temple University, Sherbert Willows.

LATIF: Dani Bennett and Monica Johnson, Shari Sinwelski and the folks at Didi Hirsch, Jagjaguwar Records, and George Colt for sharing his cassette-taped interviews of Ed Shneidman with us.

LULU: And big special thanks again to S. Carey for his original song, "You Are Not Alone." And for all his other work, which you can go listen to wherever you listen to the musics.

LATIF: That's it.

LULU: Thanks so much for listening, and for sticking with us. Catch you next week.

[LISTENER: Hi, I'm Rahid and I'm from Pittsburgh. Radiolab was created by Jad Abumrad and is edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co-hosts. Dylan Keefe is our director of sound design. Our staff includes: Simon Adler, Jeremy Bloom, Becca Bressler, Ekedi Fausther-Keeys, W. Harry Fortuna, David Gebel, Maria Paz Gutiérrez, Sindhu Gnanasambandan, Matt Kielty, Annie McEwen, Alex Neason, Sarah Qari, Sarah Sandbach, Arianne Wack, Pat Walters and Molly Webster. Our fact-checkers are Diane Kelly, Emily Krieger and Natalie Middleton.]

[LISTENER: Hi, this is Ellie from Cleveland, Ohio. Leadership support for Radiolab's science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, a Simons Foundation initiative, and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.]

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