Tag Archives: myths

2/22/22: A Penchant for Redundancy: My Re-description of Four Suicide Myths

Back in the days when video recording involved film rather than digits, editors would talk about leaving excellent footage “on the floor.” How do I know this? I was alive back in the day.

Today I’ve been working on revising a continuing education “course” for ContinuingEdCourses.net. The course has been popular and so the ContinuingEdCourses.net owners asked for a revision. I stalled until they recognized my stalling for what it was essentially told me I was overdue and late, which made me decide it would feel better to finish the revision than it would to keep procrastinating. I’m guessing maybe others of you out there can relate to that particular moment in time.

While editing and revising I discovered (actually I rediscovered) my penchant for redundancy. Sometimes that penchant is intentional and other times the penchant is an annoying rediscovery. This paragraph that you’re reading in the here-and-now includes an intentional penchant. The CE course included an unintentional penchant. Are you familiar with the research on the overuse of words? If you repeat a word over and over, after only a few seconds you can become desensitized to the meaning of the word and the word will just sound like a sound. I’m feeling a penchant for that too.

Bottom line: I had to cut some nice content. It ended up on the metaphorical floor, until I picked it up, dusted it off, and put it in this blog. Here you go. . .

Editor’s note [BTW, I’m the editor here, because it’s my blog, so I own all the mistakes, misspellings, and misplaced commas]: Turns out I edited out the other redundant content, but I’m posting this anyway, because it’s still 2/22/22, which happens to be most redundant date of the year. Now, here you go. . .

Four Suicide Myths

The word “myth” has two primary meanings.:

A myth is a traditional or popular story or legend used to explain current cultural beliefs and practices. This definition emphasizes the positive guidance that myths sometimes provide. For example, the Greek myth of Narcissus warns that excessive preoccupation with one’s own beauty can become dangerous. Whether or not someone named Narcissus ever existed is irrelevant; the story tells us that too much self-love may lead to our own downfall.

The word myth is also used to describe an unfounded idea, or false notion. Typically, the false notion gets spread around and, over time, becomes a generally accepted, but inaccurate, popular belief. One contemporary example is the statement, “Lightning never strikes the same place twice.” In fact, lightning can and does strike the same place twice (or more). During an electrical storm, standing on a spot where lightning has already struck, doesn’t make for a good safety strategy.

The statement “We only use 10% of our brains” is another common myth. Although it’s likely that most of us can and should more fully engage our brains, scientific researchers (along with the Mythbusters television show) have shown that much more than 10% of our brains are active most of the time – and probably even when we’re sleeping.

False myths can stick around for much longer than they should; sometimes they stick around despite truckloads of contradictory evidence. As humans, we tend to like easy explanations, especially if we find them personally meaningful or affirming. Never mind if they’re accurate or true.

Historically, myths were passed from individuals to groups and other individuals via word of mouth. Later, print media was used to more efficiently communicate ideas, both factual and mythical. Today we have the internet and instant mythical messaging.

Suicide myths weren’t and aren’t designed to intentionally mislead; mostly (although there are some exceptions) they’re not about pushing a political agenda or selling specific products. Instead, suicide myths are the product of dedicated, well-intended people whose passion for suicide prevention sometimes outpaces their knowledge of suicide-related facts (Bryan, 2022).

Depending on your perspective, your experiences, and your knowledge base, it’s possible that my upcoming list of suicide myths will push your emotional buttons. Maybe you were taught that “suicide is 100% preventable.” Or, maybe you believe that suicidal thoughts or impulses are inherently signs of deviance or a mental disturbance. If so, as I argue against these myths, you might find yourself resisting my perspective. That’s perfectly fine. The ideas that I’m labeling as unhelpful myths have been floating around in the suicide prevention world for a long time; there’s likely emotional and motivational reasons for that. Also, I don’t expect you to immediately agree with everything in this document. However, I hope you’ll give me a chance to make the case against these myths, mostly because I believe that hanging onto them is unhelpful to suicide assessment and prevention efforts.

Myth #1: Suicidal thoughts are about death and dying.

Most people assume that suicidal thoughts are about death and dying. Someone has thoughts about death, therefore, the thoughts must literally be about death. But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.

Let’s look at a parallel example. Couples who come to counseling often have conflicts about money. One partner likes to spend, while the other is serious about saving. From the surface, you might mistakenly assume that when couples have conflicts about money, the conflicts are about money – dollars, cents, spending, and saving. However, romantic relationships are complex, which is why money conflicts are usually about other issues, like love, power, and control. Nearly always there are underlying dynamics bubbling around that fuel couples’ conflicts over money.

Truth #1: Among suicidologists and psychotherapists, the consensus is clear: suicidal thoughts and impulses are less about death and more about a natural human response to intense emotional and psychological distress (aka psychache or excruciating distress). I use the term “excruciating distress” to describe the intense emotional misery that nearly always accompanies the suicidal state of mind. The take-home message from busting this myth should help you feel relief when clients mention suicide. You can feel relief because when clients trust you enough to share their suicidal thoughts and excruciating distress with you, it gives you a chance to help and support them. In contrast, when clients don’t tell you about their suicidal thoughts, then you’re not able to provide them with the services they deserve. Your holding an attitude that welcomes client openness and their sharing of distress and suicidal thoughts is foundational to effective treatment.

Myth #2: Suicide and suicidal thinking are signs of mental illness.

Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another – even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.” Additionally, the rates of suicidal thinking among high school and college students is so high (estimates of 20%-40% annual incidence) that it’s more appropriate to label suicidal thoughts as common, rather than a sign of deviance or illness.

Edwin Shneidman – the American “Father” of suicidology – denied a relationship between suicide and so-called mental illness in the 1973 Encyclopedia Britannica, stating succinctly:

Suicide is not a disease (although there are those who think so); it is not, in the view of the most detached observers, an immorality (although … it has often been so treated in Western and other cultures).

A recent report from the U.S. Centers for Disease Control (CDC) supports Shneidman’s perspective. The CDC noted that 54% of individuals who died by suicide did not have a documented mental disorder (Stone et al., 2018). Keep in mind that the CDC wasn’t focusing on people who only think about or attempt suicide; their study focused only on individuals who completed suicide. If most individuals who die by suicide don’t have a mental disorder, it’s even more unlikely that people who think about suicide (but don’t act on their thoughts), suffer from a mental disorder. As Wollersheim (1974) used to say, “Having the thought of suicide is not dangerous and is not the problem (p. 223).”

Truth #2: Suicidal thoughts are not – in and of themselves – a sign of illness. Instead, suicidal thoughts arise naturally, especially during times of excruciating distress. The take-home message here is that clinicians should avoid judgment. I know that’s a tough message, because most of us are trained in diagnosing mental disorders and as we begin hearing of signs of depression, emotional lability, or other symptoms, it’s difficult not to begin thinking in terms of psychopathology. However, especially during initial encounters with clients who have suicidal ideation, it’s deeply important for us to avoid labeling – because if clients sense clinicians judging them, it can increase client shame and decrease the chances of them sharing openly.

Myth #3: Scientific knowledge about suicide risk factors and warning signs support accurate allows for the prediction and prevention of suicide.

As discussed previously, mMost suicidologists agree: that Ssuicide is extremelyvery difficult to predict (Franklin et al., 2017).

To get perspective on the magnitude of the problem, imagine you’re at the Neyland football stadium at the University of Tennessee. The stadium is filled with 100,000 fans. Your job is to figure out which 13.54 of the 100,000 fans will die by suicide over the next 365 days.

A good first step would be to ask everyone in the stadium the question that many suicide prevention specialists ask, “Have you been thinking about suicide?” Assuming the usual base rates and assuming that every one of theall 100,000 fans answer you honestly, you might rule out 85,000 people (because they say they haven’t been thinking about suicide). Then you ask them to leave the stadium. Now you’re down to identifying which 13.54 of 15,000 will die by suicide.

For your next step you decide to do a quick screen for the diagnosis of clinical depression. Let’s say you’re highly efficient, taking only 20 minutes to screen and diagnose each of the 15,000 remaining fans. Never mind that it would take 5,000 hours. The result: Only 50% of the 15,000 fans meet the diagnostic criteria for clinical depression.

At this point, you’ve reduced your population to 7,500 University of Tennessee fans, all of whom are depressed and thinking about suicide. How will you accurately identify the 13 or 14 fans who will die by suicide? Mostly, based on mathematics and statistics, you won’t. Every effort to do this in the past has failed. Your best bet might be to provide aggressive pharmacological or psychological treatment for the remaining 7,500 people. If you choose antidepressant medications, you might inadvertently make about 200-250 of your “patients” even more suicidal. If you use psychotherapy, the time you need for effective treatment will be substantial. Either way, many of the fans will refuse treatment, including some of those who will later die by suicide. Further, as the year goes by, you’ll discover that several of the 85,000 fans who denied having suicidal thoughts, and whom you immediately ruled out as low risk, will confound your efforts at prediction and die by suicide.

To gain a broader perspective, imagine there are 3,270 stadiums across the U.S., each with 100,000 people, and each with 13 or 14 individuals who will die by suicide over the next year. All this points to the enormity of the problem. Most professionals who try to predict and prevent suicide realize that, at best, they will help some of the people some of the time.

Truth #3: Although there’s always the chance that future research will enable us to predict suicide, decades of scientific research don’t support suicide as a predictable event. Even if you know all the salient suicide predictors and warning signs, in the vast majority of cases you won’t be able to efficiently predict or prevent suicide attempts or suicide deaths. The take-home message from busting this myth is this: Lower your expectations about accurately categorizing client risk. Most of the research suggests you’ll be wrong (Bryan, 2022; Large & Ryan, 2014). Instead, as you explore risk factors with clients, use your understanding of risk factors as a method for deepening your understanding of the individual client with whom you’re working.

Myth #4: Suicide prevention and intervention should focus on eliminating suicidal thoughts.

Logical analysis implies that if psychotherapists or prevention specialists can get people to stop thinking about suicide, then suicide should be prevented. Why then, do the most knowledgeable psychotherapists in the U.S. advise against directly targeting suicidal thoughts in psychotherapy (Linehan, 1993; Sommers-Flanagan & Shaw, 2017)? The first reason is because most people who think about suicide never make a suicide attempt; that means you’re treating a symptom that isn’t necessarily predictive of the problem. But that’s only the tip of the iceberg.

After his son died by suicide, Rick Warren, a famous pastor and author, created a YouTube video titled, “Rick Warren’s Message for Those Considering Suicide.” The video summary reads,

If you have ever struggled with depression or suicide, Pastor Rick has a message for you. The pain you are experiencing will not last forever. There is hope!

Although over 1,000 viewers clicked on the “thumbs up” sign for the video, there were 535 comments; nearly all of these comments pushed back on Pastor Warren’s well-intended video message. Examples included:

  • Are you kidding me??? You’ve clearly never been suicidal or really depressed.
  • To say “Suicide is a permanent solution to a temporary problem” is like saying: “You couldn’t possibly have suffered long enough, even if you’ve suffered your entire life from many, many issues.”
  • This is extremely disheartening. With all due respect. Pastor, you just don’t get it.

Pastor Rick isn’t alone in not getting it. Most of us don’t really get the excruciating distress, deep self-hatred, and chronic shame linked to suicidal thoughts and impulses. And because we don’t get it, sometimes we slip into try toing rationally persuadesion to encourage individuals with suicidal thoughts to regain hope and embrace life. Unfortunately, a nearly universal phenomenon called “psychological reactance” helps explain why rational persuasion – even when well-intended – rarely makes for an effective intervention (Brehm & Brehm, 1981).

While working with chronically suicidal patients for over two decades, Marsha Linehan of the University of Washington made an important discovery: when psychotherapists try to get their patients to stop thinking about suicide, the opposite usually happens – the patients become more suicidal.

Linehan’s discovery has played out in my clinical practice. Nearly every time I’ve actively pushed clients to stop thinking about suicide – using various psychological ploys and techniques – my efforts have backfired.

Truth #4: Most individuals who struggle with thoughts of suicide resist outside efforts to make them stop thinking about suicide. Using direct persuasion to convince people they should cheer up, have hope, and embrace life is rarely effective. The take-home message associated with busting this myth is that the best approaches to working with clients who are suicidal are collaborative. Instead of taking the role of an esteemed authority who knows what’s best for clients, effective counselors and psychotherapists take a step back and seek to activate their client’s expertise as collaborators onagainst the suicidal problem.

The Myth of Suicide Risk and Protective Factors

 

HummingbirdMyths are fascinating, resilient ideas that openly defy reality.

Some people say, “All myths are based in truth.” Well, maybe so, but tracking down the myth’s truthful origins reminds me of my friends back in high school who used to take their dates snipe hunting. Maybe the idea that all myths are based in truth is a myth too?

Suicide is a troubling problem (this is an obvious understatement). To deal with this troubling problem, one of the tools that most well-intended prevention programs advocate is to watch for suicide risk factors and warning signs, and when you see them, intervene. This would be great guidance if only useful or accurate suicide risk factors and warning signs existed. Sadly, like the snipe, you can look all night for useful or accurate risk factors and still come up empty.

I’m writing about mythical risk factors and warning signs today because I just covered this content in our suicide assessment and treatment manuscript. In the following excerpt, we’re writing about suicide competencies for mental health professionals:

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Cramer and colleagues (2013) noted, “One of the clinician’s primary objectives in conducting a suicide risk assessment is to elicit risk and protective factors from the client” (p. 6). As we’ll discuss in greater detail later, this competency standard is problematic for at least three reasons. First, in an extensive meta-analysis covering 50-years of research, the authors concluded: “All [suicide thoughts and behavior] risk (and protective factors) are weak and inaccurate. This general pattern has not changed over the past 50 years” (Franklin, et al., 2017, p. 217).

Second, the number of potential risk and protective factors that counselors should be aware of is overwhelming. Granello (2010a) reported 75+ factors, we have a list of 25 (Sommers-Flanagan & Sommers-Flanagan, 2017), and even Cramer and colleagues lamented, “It would be impossible for clinicians to be familiar with every risk factor” (p. 6). Jobes (2016) referred to suicidology as “a field that has been remarkably obsessed with delineating countless suicide ‘risk factors’ (that do little for clinically understanding acute risk)” (p. 17).

Third, prominent suicide researchers have concluded that using risk and protective factors to categorize client risk is ill-advised (McHugh, Corderoy, Ryan, Hickie, & Large, 2019; Nielssen, Wallace, & Large, 2017). For example, even the most common suicide symptom and predictor (i.e., suicide ideation), is a poor predictor of suicide in clinical settings; this is because suicide ideation occurs at a very high frequency, but death by suicide occurs at a very low frequency. In one study, 80% of patients who died by suicide denied having suicidal thoughts, when asked directly by a general medical practitioner (McHugh et al., 2019). Even the oft-cited risk factor of previous suicide attempt has little bearing whether or not individuals die by suicide.

When AAS (2010) and Cramer and his colleagues (2013) described the risk and protective factor competency, eliciting risk and protective factors from clients was standard professional practice. However, in recent years, researchers have begun recommending that practitioners avoid using risk and protective factors to categorize client risk as low, medium, or high—principally because these categorizations are usually incorrect (Large, & Ryan, 2014). In a review of 17 studies examining 64 unique suicide prediction models, the authors reported that “These models would result in high false-positive rates and considerable false-negative rates if implemented in isolation” (Belsher et al., 2019, p. 642).

To summarize, this suicide competency boils down to four parts:

  1. Competent practitioners should still be aware of evidence-based suicide risk and protective factors.
  2. Competent practitioners are aware that evidence-based suicide risk and protective factors may not confer useful information during a clinical interview.
  3. Instead of over-relying on suicide risk and protective factor checklists, competent practitioners identify and explore client distress and then track client distress back to individualized factors that increase risk and enhance protection.
  4. Competent practitioners use skills to collaboratively develop safety plans that address each client’s unique risk and protective factors.

Although risk and protective factors don’t provide an equation that tell clinicians what to do, knowing and addressing each unique individual’s particular risks and strengths remains an important competency standard.

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As always, even though getting feedback on this blog is yet another mythical phenomenon,  please send me your thoughts and feedback!

 

 

 

Four Suicide Myths (and Truths) — Part I

Let’s start with a myth and a truth.

Myth: Rita bought me a pair of “Joker” pants (as in Batman). I think wearing them will make me funnier.

Truth: Wearing them makes me look funny, but they don’t actually make me funnier.

Joker Pants

The word “myth” has two primary meanings.

A myth is a traditional or popular story or legend used to explain current cultural beliefs and practices. This definition emphasizes the positive guidance that myths sometimes provide. For example, the Greek myth of Narcissus warns that excessive preoccupation with one’s own beauty can become dangerous. Whether or not someone named Narcissus ever existed is irrelevant; the story tells us that too much self-love can lead to our own downfall.

The word myth is also used to describe an unfounded idea, or false notion. Typically, the false notion gets spread around and, over time, becomes a generally accepted, but inaccurate, popular belief. One contemporary example is the statement, “Lightning never strikes the same place twice.” In fact, lightning can and does strike the same place twice (or more). During an electrical storm, standing on a spot where lightning has already struck, isn’t a good safety strategy. . . and wearing “Joker” pants won’t necessarily make you funnier.

The statement “We only use 10% of our brains” is another common myth. Although it’s likely that most of us can and should more fully engage our brains, scientific researchers (along with the Mythbusters television show) have shown that much more than 10% of our brains are active most of the time—and probably even when we’re sleeping.

False myths stick around for much longer than they should, sometimes they stick around despite truckloads of contradictory evidence. As humans, we like easy explanations, especially if we find them personally meaningful or affirming. Never mind if they’re accurate or true.

Not long ago I was discussing sex education with a group of teenagers. Several of them reported—with great confidence—that if a woman is on top during intercourse she can’t get pregnant.

“How might that work?” I asked.

“Gravity,” the leader explained. The rest of group nodded in agreement. “Sperm can’t swim uphill.”

Immediately, I tried to dispute their gravitational theory of birth control. To me, their belief in a birth control myth would likely lead to unhappy outcomes. But the teenagers held their ground.

Historically, myths were passed from individuals to groups and other individuals via word of mouth. Later, print media was used to more efficiently communicate ideas, both factual and mythical. Today we have the internet and instant mythical messaging.

Unfortunately, some myths are used for political or financial gain. Other myths, like the gravitational theory of birth control, lead to unplanned and adverse outcomes. Today, primarily through the internet, people are pummeled with information, misinformation, and outright lies. Despite amazing scientific, psychological, and technical progress, sorting fact from fiction remains an enormous challenge.

Suicide myths weren’t and aren’t designed to intentionally mislead; mostly (although there are some exceptions) they’re not about pushing a political agenda or selling specific products. Instead, suicide myths are the product of dedicated, well-intended people whose passion for suicide prevention sometimes outpaces their knowledge of suicide-related facts.

In some cases, people believe so hard in certain suicide myths that they cling to and defend their myths, even when the myths have become dysfunctional and even in the face of substantial contrary logical and empirical evidence. Thinking back to the teenagers and their gravitational theory of birth control, I recall their response to my scientific rebuttal. One of them said, “Well. Maybe so, but that’s what I heard, and it still makes sense to me. Even if sperm can swim uphill, gravity must make it harder to get a woman pregnant if she’s on top.”

When suicide (or birth control) myths take on a life of their own despite contradictory evidence, it’s usually because the myths have deep emotional roots or because people have an incentive that motivates them to hang on to their mythical beliefs.

Depending on your perspective, experiences, and your knowledge base, it’s possible that my list of suicide myths will push your emotional buttons. Maybe you were taught that “suicide is 100% preventable.” Or maybe you believe that suicidal thoughts or impulses are inherently signs of deviance or a mental disturbance. If so, as I argue against these myths, you might find yourself resisting my perspective. That’s perfectly fine. The ideas that I’m labeling as unhelpful myths have been floating around in the suicide prevention world for a long time; there’s likely emotional and motivational reasons for that. Also, I don’t expect you to immediately agree with everything in this book. However, I hope you’ll give me a chance to make the case against these myths, mostly because I believe that hanging onto them is unhelpful to suicide assessment and prevention efforts.

In this chapter, I list the four myths and provide brief descriptions. Read them, see what you think, and notice your reactions. In the next 4 chapters, we’ll dive deeper into evidence against these myths, why they’re potentially destructive, and alternative ways to think about suicide and suicide prevention.

Myth #1: Suicidal thoughts are about death and dying.

Most people assume that suicidal thoughts are about death and dying. It seems like a no-brainer: Someone has thoughts about death, therefore, the thoughts must be about death.

But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.

Let’s look at a parallel example. Couples who come to counseling often have conflicts about money. One partner likes to spend and the other is serious about saving. From the surface, you might mistakenly assume that when couples have conflicts about money, the conflicts are about money—dollars, cents, spending, and saving. However, romantic relationships are complex, which is why money conflicts are usually about other issues, like love, power, and control. Nearly always there are dynamics bubbling under the surface that fuel couples’ conflicts over money.

Truth #1: Among suicidologists and psychotherapists, the consensus is clear: suicidal thoughts and impulses are less about death and more about a natural human response to intense emotional and psychological distress. I use the term, excruciating distress to describe the intense emotional misery that nearly always accompanies the suicidal state of mind.

My New Favorite Book (for now) and Why I Love Quiche

In elementary school in the 1960s, my reading almost exclusively included comics. I didn’t just love Captain America, I wanted to BE Captain America.

Unfortunately, I was in high school in the early 1970s, when reading books was apparently in disfavor. We used the SRA Laboratory Reading System and the only real “book” I recall reading in all of high school was “The Andromeda Strain.” Of course, the problem was likely partly due to my preoccupation with athletics over academics, but that’s a different story.

What this means is that most of my book reading has occurred after 1975, which is when my football buddy Barry and I read, “Real Men Don’t Eat Quiche.” The problem with that was that I happened to like quiche . . . a lot . . . and consequently, rather than questioning my sexual identity, I began questioning what society tells real men that they should do and not do.

This leads me to my book pick of the week.

As some of you already know, I’m working on a writing project related to sexual development in young males. This work led me to discover the book “Delusions of Gender” by Cordelia Fine, Ph.D. Dr. Fine is a psychologist in Australia and has written an absolutely awesome book that slices through many of the silly connections people are making between neuroscience and gender. For example, as an opening to chapter 14 “Brain Scams,” she wrote:

“My husband would probably like you to know that, for the sake of my research for this chapter, he has had to put up with an awful lot of contemptuous snorting. For several weeks, our normally quiet hour of reading in bed before lights out became more like dinnertime in the pigsty as I worked my way through popular books about gender difference. As the result of my research, I have come up with four basic pieces of advice for anyone considering incorporating neuroscientific findings into a popular book or article about gender” (p. 155).

You’re probably wondering, what is her excellent advice for those of us considering writing in this area? Well, I’m resisting the temptation within my male brain to type out her advice, other than her fourth piece of advice, which reads: “Don’t make stuff up.”

But that’s exactly what many writers are doing. Here’s an example I found recently. It’s titled, “7 things he’ll never tell you” and written by “Dr.” Kevin Leman. He wrote, “Did you know that scientific studies prove why a woman tends to be more ‘relational” than her male counter part? A woman actually has more connecting fibers than a man does between the verbal and the emotional side of her brain. That means a woman’s feelings and thoughts zip along quickly, like they’re on an expressway, but a man’s tend to poke slowly as if he’s walking and dragging his feet on a dirt road.” (pp. 5-6).

Of course, this is sheer drivel . . . or as Dr. Fine might say, “He just made that up.”

Or as I might say: He’s really just talking about himself here . . . and it’s likely caused by the fact that he didn’t eat enough quiche growing up.

So what’s the evidence? If we look at one of the best relational factors upon which women are supposed to be better than men–empathy–what does the research say?

Well, as it turns out, using the best and most rigorous laboratory empathy measure available, empathy researcher William Ickes found no differences between males and females in seven consecutive studies. And then, when he did find differences, he found women did better only in situations where they are primed by “situational cues that remind them that they, as women, are expected to excel at empathy-related tasks.” (Fine, p. 21).

Anyway, it’s late and I’m going to stop writing . . . but not before I put in a link to a Cordelia Fine speech you can watch online. Here it is:  http://fora.tv/2010/10/02/Cordelia_Fine_Delusions_of_Gender

Now I’m off to bake myself a quiche.