Suicidal Behavior, Science, & Mixed Martial Arts with Dr. David Klonsky

Dr. David Klonsky is a clinical psychology professor who conducts research on suicidal behavior, personality, emotion, and assessment. He developed the three-step theory, which is an important and parsimonious theory of suicidal behavior. David also conducted foundational work on the functions of nonsuicidal self-injury. After discussing suicidal behavior research, we shifted the conversation to open science and criticism of National Institute of Mental Health grant funding priorities. Then, we talked about mixed martial arts – both our own experiences and David’s work consulting with athletes competing in combat sports. We concluded with thoughts about why Buffy the Vampire Slayer and Star Wars are so good. This episode was SO much fun to make, and we hope you enjoy listening to it!

Show Notes

Suicide Research

You can follow Dr. David Klonsky on Twitter and check out his lab’s research on Google Scholar. For example, I recommend:

Ideation-to-Action Theories of Suicide: A Conceptual and Empirical Update

The Role of Theory for Understanding and Preventing Suicide (But Not Predicting It): A Commentary on Hjelmeland and Knizek

On the episode, I mentioned that I wrote a blog post about the three-step theory and how I believe it can advance public discussion about suicide.

Mixed Martial Arts Media Appearances

You can also follow David’s MMA Twitter account.

5 Rounds: Psychology of MMA, Mark Bocek on Bendo vs. Thomson and More – Fight Network

Ronda Rousey’s Return at UFC 207 – Fight Network

Connor McGregor’s Winning Ways; Mentally Breaking Opponents – Fight Network

Suicide prevention information and resources are available here and you can learn more about nonsuicidal self-injury here.

The Remarkable Resilience of Princess Leia

Psychological Report

Name: Leia Organa
Date and Location of Birth: A long time ago in a galaxy far, far away….
Ethnicity/Race: Force-sensitive human
Date of Initial Interview: December 18, 2015
Date of Report: May the 4th, 2016
Therapists: Brandon Saxton, M.S., Katie Gordon, Ph.D.

Presenting Problem
General Leia Organa presented for treatment as a strong, witty, and compassionate woman in her 50s who was referred for treatment by a concerned friend, Chewbacca, for “uuhgguughhhghghghhhgh wuuh raaaaahhgh uugggh aguhwgggghhh raaaaaahhgh huuguughhg.” Translated from Shyriiwook, that meant that she recently suffered the traumatic loss of her ex-husband (Han Solo) at the hands of her son (Ben Solo, aka Kylo Ren, aka Matt the Radar Technician). 

Leia reported viewing the timeline of her life as clustering into a series of events that felt like distinct episodes. When asked to elaborate, she provided details about five of these so-called episodes.

Episode III
Leia and her twin brother, Luke Skywalker, were born 19 years before the Battle of Yavin on Polis Massa to their biological mother, Padme Amidala. Tragically, Padme died immediately following childbirth. Meanwhile, their biological father, Anakin Skywalker (Darth Vader) had turned to the dark side and would not have been a suitable parent. A family friend and mentor, Obi-Wan Kenobi, took great care to place Luke and Leia in loving homes. The twins were reared apart: Luke was raised on Tattooine by his step-aunt and step-uncle, while Leia was adopted by Senator Bail and Queen Breha Organa and raised on Alderaan.

Episode IV
The Organas were a royal family, and Leia was a princess on Alderaan. By age 19, she was a member of the Imperial Senate like her father before her. She also worked with the Rebel Alliance, a group fighting the evil Empire. After the Rebels stole the plans for the Empire’s massive weapon (the Death Star), they were given to Leia, a testament to the high regard in which she was held. Darth Vader captured Leia, tortured her, and utilized a mind probe in order to learn the location of the Rebel base. However, none of these strategies were effective on Leia, who exhibited exceptional fortitude and refused to reveal the base location. In response, the Empire tragically destroyed her home planet, killing her entire family. She was ultimately freed from capture by a smuggler named Han Solo, Chewbacca (Han’s co-captain), Obi-Wan Kenobi, and Luke (who she did not know was her brother at the time), and re-emerged as a major player in the ultimately successful mission to destroy the Death Star.

Episode V
Leia continued in a leadership role against the Empire, which attacked the Rebel Alliance’s base on the planet Hoth. She organized the evacuation of the base and then escaped with Han and Chewbacca on their ship, the Millenium Falcon. During their challenging voyage from Hoth to Cloud City to seek ship repairs, Han and Leia fell in love. When they arrived at Cloud City, Darth Vader captured them. He froze Han in carbonite and gave him to a bounty hunter (Boba Fett), who was hired by a gangster named Jabba the Hutt. Eventually, Leia and Chewy escaped Darth Vader with the assistance of Han’s friend, Lando Calrissian, and reunited with Luke. 

Episode VI
Leia courageously developed a plan to disguise herself and rescued Han from Jabba. Unfortunately, she was later captured and enslaved by Jabba. Leia’s bravery, resourcefulness, and strong interpersonal connections helped her to break free (with the help of Lando). She and her friends then went to Endor to continue fighting with the Rebels against the Empire’s second Death Star. With some help from the Ewoks, they successfully defeated the Imperial forces. This episode was particularly significant because Leia learned that Luke was her twin brother and that Darth Vader (now deceased) was her father, and she reaffirmed her love for Han. Leia recalled this period as the beginning of one of the happiest times in her life.

Episode VII
For a while, Han and Leia had a wonderful life together, got married, and had children. The happiness did not last, however. One of their sons, Ben, was training as a young Jedi with Luke and turned to the dark side. Ben took the name Kylo Ren and began working as a commander for the evil First Order. This absolutely devastated Han, Leia, and Luke. Feeling helpless and heartbroken, Han and Leia separated and turned to their old lines of work for solace and distraction while Luke disappeared. Han returned to smuggling with Chewbacca and Leia became the General of the Resistance, leading the fight against the First Order. Circumstances brought Leia and Han together again to fight the First Order, and it was clear that they still shared a deep love and respect for one another. As Han left to disable the First Order’s weapon (Starkiller Base), Leia pled with him to bring their son home, saying, “There is still light in him. I know it.” He tried his best to bring Ben back home, but tragically, Kylo Ren killed Han.

Diagnostic Impressions
All diagnostic assessment information was gathered through behavioral observations (i.e., watching Star Wars movies). Based on the losses and traumatic events Leia went through, it was hypothesized that the most likely disorder that Leia might be experiencing, or be at risk for, was post-traumatic stress disorder (PTSD). When considering the diagnostic criteria for PTSD offered in the current version of the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), Leia certainly faced traumatic events (e.g., loss of her home planet, loss of her father, loss of her husband, and the loss of her son to the dark side of the Force). However, Leia did not exhibit any of the other diagnostic features (e.g., re-experiencing of the traumatic event, avoidance of related objects or environments, or hyperarousal) associated with PTSD. Beyond that, Leia did not seem to exhibit any other symptoms related to mental disorders. Her emotional response appeared to be an expected amount of grief and emotional pain in light of the circumstances.

Treatment Recommendations
In summary, Leia does not currently meet the diagnostic criteria for any specific mental disorder. Overall, she appeared to be displaying an appropriate amount of grief given the tremendous amount of loss she had experienced. It is recommended that Leia return for a follow-up session to assess her mental health once some more time has passed to determine whether Leia experiences a normal grieving process. In situations like this, even in the absence of a specific disorder, it is possible for complicated grief to develop. Complicated grief is when an individual engages in avoidant coping strategies while never actually processing through their emotions. Oftentimes, this leads to increased risk for psychological disorders.

In the meantime, Leia should continue to engage in good self-care, embrace social support, and return to therapy if needed. Supportive counseling or bereavement support groups are also options for Leia, should she decide to seek additional help.

Follow-up Appointment: Scheduled for December 15, 2017


Was the portrayal of mental health concerns accurate?

It seems unlikely that Princess Leia was written with the goal of portraying any specific mental disorders, particularly given that she isn’t shown to be experiencing any significant symptoms. That being said, the manner in which she handles challenges and losses is certainly within the realm of realism for someone with her resources and personality characteristics. Moreover, while many people develop PTSD in the face of trauma, the majority of people do not. Therefore, the depiction is accurate in that sense as well.

Was the person with mental health concerns depicted with compassion?

As depicted so far, Leia is not experiencing any mental health symptoms; however, we do feel that she is depicted compassionately. The reality is that all individuals face loss, challenges, and adversity in different ways. Leia is seemingly able to navigate these tremendous hurdles with strength and grace. Not only is she able to maintain her personal values and continue pursuing her own goals, she also often provides emotional support and guidance to others.

Overall rating:

On a rating scale from Star Wars: The Holiday Special (it really is terrible) to Star Wars: The Empire Strikes Back (probably our favorite in the series), we give Princess Leia the rating of…. Empire Strikes Back! Princess Leia is a role model for all of us. She is brave, caring, intelligent, and does her best to help others even at great personal risk. Everyone around her looks to her for strength and leadership.

Finally, it is also worth noting that Carrie Fisher, the actress who plays Leia Organa, has been open about her own struggles with mental health issues including bipolar disorder and addiction. She fights stigma and has been a real-life hero to many people.

Diagnosing Darth Vader


Name: Anakin Skywalker (Darth Vader)DD
Date of Birth: 41 B.B.Y.
Age: 46 (at death)
Ethnicity/Race: Force-Sensitive Human
Education: Jedi Knight, Sith Lord
Date of Report: 03/01/16
Therapists: Katie Gordon, Ph.D., Brandon Saxton, B.S.

Presenting Problem

Anakin Skywalker (Darth Vader) presented as a widowed, 46-year-old man, who was referred for treatment by his son, Luke Skywalker. Specifically, his son expressed concern about his father’s persistent and pervasive pattern of violent, self-centered behavior, which caused significant distress and impairment to his family, co-workers, and the galaxy as a whole.


Anakin Skywalker was a Force-sensitive, human born on the desert planet, Tatooine. Anakin was presumed to be born of the will of the Force with no biological father. His mother, Shmi Skywalker, was enslaved when he was born. As such, Anakin was born into slavery as well. As a child, Anakin was noted for his kindness, generosity, intelligence, and willingness to risk his life for others. Even at a young age, Anakin was a very skilled pilot and mechanic.

At age nine, Anakin met Jedi Master Qui-Gon Jinn. Qui-Gon recognized Anakin as being Force-sensitive. Upon testing Anakin’s midichlorian count, it was revealed that he had a higher count than any other Jedi. Qui-Gon, who needed parts for his ship to leave the planet, bet on Anakin in an upcoming pod race. Through his skill as a pilot, Anakin won the pod race, winning not only the needed spaceship parts, but his freedom as well. Qui-Gon asked Anakin to leave the planet with him, hoping that the Jedi Council would allow him to take Anakin as a padawan learner. It was then that Qui-Gon began to suspect that Anakin might be the Chosen One, prophesized to bring balance back to the Force. With excitement, anxiety, and some regret, Anakin left his mother to train with Qui-Gon. Unfortunately, the Jedi Council ruled that Anakin was too old to begin training as a Jedi.

Qui-Gon and his padawan at the time, Obi-Wan Kenobi, were sent on a mission to protect Queen Padme Amidala. The two Jedi faced the Sith Lord, Darth Maul, and Qui-Gon was killed in the battle. With his dying breath, Qui-Gon asked Obi-Wan to take Anakin as a padawan learner despite the ruling of the Jedi Council. It was then that Anakin began his Jedi training.

Anakin’s training under Obi-Wan was not always smooth. Because he began his training at an older age, the other padawan learners were not always accepting of him. Anakin already appeared to have an emotionally labile temperament, and the stressors that he faced (e.g., being a slave, leaving his mother behind, being initially denied by the Jedi Council, losing Qui-Gon Jinn) further fueled those flames. During this period, Anakin started to become aware of how powerful his connection to the Force was. As such, he started to develop a flair of arrogance and sense of superiority over other padawan learners. Observing the power that Anakin possessed led Senator (and eventually Supreme Chancellor) Sheev Palpatine to express interest in young Anakin.

Years later, Anakin met Padme Amidala (then a senator) again, and developed intense, romantic feelings for her. His mentor, Obi-Wan, reminded and warned Anakin that those kind of feelings are expressly forbidden by the Jedi Order, as they often lead to the dark side of the Force. While Anakin was on a solo mission to protect Padme, he experienced dreams of his mother experiencing pain. Anakin believed that his dreams were a vision and quickly left with Padme to return to Tatooine. When he arrived, he found that his mother had been abducted by Tusken Raiders. Anakin found the village she was taken to, but it was too late – she died in his arms. Filled with intense rage, he slaughtered the entire village, including women and children who were not responsible for his mother’s death. He experienced immense pain and guilt at the loss of his mother and his actions. He then vowed to become powerful enough to save those he loved from death. Shortly after, he secretly married Padme.

Later on, Obi-Wan and Anakin embarked on a mission to save Palpatine from General Grevious. Despite Anakin’s reservations, Palpatine convinced him to kill Count Dooku. After the mission, Anakin learned that he was to become a father, as Padme was pregnant. They were both overjoyed by this news, but shortly after, Anakin began to have dreams about Padme dying during childbirth. Recalling how his mother died after his visions, Anakin became desperate to save Padme. He went to Master Yoda for guidance, who simply told him to let go of connections, as they lead to the dark side. Anakin was dissatisfied with Yoda’s response, which provided no comfort or solution. It was also during this period that strong distrust began to form between Palpatine, who requested Anakin to be his representative on the Jedi Council, and the Jedi Council itself, who requested Anakin to spy on Palpatine for them. Despite Anakin joining the Jedi Council to represent Palpatine, the Council still denied him the rank of Jedi Master.

Palpatine sensed the turmoil in Anakin and asked him what was troubling him. It was then that Palpatine told Anakin that he possessed the power to save an individual from death. He revealed himself to Anakin to be the Sith Lord who the Jedi Council were hunting for. He warned Anakin that if he turned him over to the Jedi Council, he would never be able to teach him to save Padme. Jedi Master Mace Windu, Anakin, and other Jedi went to arrest Palpatine. Palpatine defeated some of the Jedi, but right as Windu was about to overpower him, Anakin saved Palpatine, killing Windu. It was then that Anakin realized he had truly fallen to the dark side. Palpatine renamed him Darth Vader. Vader then lead the assault on the Jedi temple, killing all of the Jedi there, including the younglings. He then traveled to Mustafar and killed the entire Separatist Council, effectively ending the Clone Wars. Padme fled to Mustafar to try to get Vader to see the light again. When Vader saw that Obi-Wan was with her, he attacked Padme, Force-choking her. Obi-Wan attacked and dismembered Vader and left him for dead. Palpatine found Vader and rebuilt his body, resulting in him being more machine than human. Palpatine also told Vader that in his rage, he killed Padme. Vader did not know that his children survived.

Having lost his family and friends, Vader felt he had nothing left. Consequently, he became strongly loyal to the now Emperor Palpatine and embraced his new role as an enforcer for the Empire. During this period, he was described as ruthless, merciless, heartbroken, self-loathing, devoted, in emotional and physical pain, impatient, and haunted by his past. He was ruthlessly effective in his new role. About 19 years into Vader’s new role, he learned that his son, Luke, had survived. For the first time in a long time, Vader felt connection and concern for another person. This would ultimately motivate him to turn back to the light before his death.

Diagnostic Impressions

All diagnostic assessment information was gleaned through behavioral observations (i.e., watching Star Wars movies). Based on his history and presenting problems, it was hypothesized that Vader met criteria for a Cluster B personality disorder. Vader exhibited symptoms of antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder. Specifically, he met five criteria for antisocial personality disorder: 1) failure to conform to social norms with respect to lawful behaviors (e.g., murders Obi-Wan Kenobi, assaults others regularly), 2) displays of irritability and aggressiveness, as indicated by repeated physical fights (e.g., using the Force to choke people), 3) reckless disregard for the safety of self or others (particularly others), and 4) lack of remorse, as indicated by being indifferent to or rationalizing having hurt or mistreated others (e.g., his justification that others, even the Jedi younglings, deserved to die). Despite these symptoms, antisocial personality disorder was ultimately ruled out due a lack of evidence of conduct disorder before age 15.

While Vader has received prior diagnoses of borderline personality disorder, the behavioral observations do not support this diagnosis. He falls short of the requirement to exhibit five or more of the nine symptoms, and only clearly meets the criteria for two symptoms: frantic efforts to avoid real or imagined abandonment (e.g., turning to the dark side in an effort to prevent Padme’s death) and intense anger and difficulty controlling anger (e.g., killing a large group of Tusken Raiders after his mother’s death, choking pregnant Padme when he thinks that she intentionally led Obi Wan Kenobi to find him in Mustafar).

The constellation of symptoms that Vader presents with appear to best be captured by a diagnosis of narcissistic personality disorder. He exhibits 1) a grandiose sense of self-importance and devalues others (e.g., regarding the Death Star, he tells Admiral Motti, “Don’t be too proud of this technological terror you’ve constructed. The power to destroy a planet is insignificant next to the power the Force,”) and 2) shows arrogant, haughty behaviors or attitudes (e.g., he tells Padme that he will be the most powerful Jedi ever), 3) a preoccupation with fantasies of unlimited success and power (e.g., he tells Padme that he will overthrow the Chancellor and, together, they will rule the galaxy and tells his son, Luke, that he can defeat the Emperor and they can rule the galaxy as father and son), 4) has a sense of entitlement  and unreasonable expectations of automatic compliance with his expectations (e.g., when Admiral Motti challenges him, Vader chokes him and says, “I find your lack of faith disturbing,” Anakin feels entitled to being named a master on the Jedi Council at a younger age than anyone else), 5) a lack of empathy/unwillingness to recognize or identify with the needs of others (e.g., refusal to see Padme and Obi-Wan’s perspectives about his choice to turn to the dark side and responding with aggression toward them), and 6) a belief that others are envious of him (e.g., tells Padme that Obi-Wan Kenobi is holding up his advancement in the Jedi Council back because of jealousy).

Treatment Recommendations

In summary, the most fitting diagnosis for Anakin Skywalker (Darth Vader) is narcissistic personality disorder. Currently, there are not any well-established treatments for narcissistic personality disorder that have been tested in large randomized clinical trials. Approaches that have been used effectively include cognitive therapy and other types of treatment focused on improving relationships with others. Due to numerous extraordinarily stressful life events (separation from his mother, the loss of his wife, being enslaved as a child, extreme physical damage to his body), Anakin developed maladaptive coping skills for dealing with his fear and anger. A therapeutic approach that prioritized building a repertoire of healthy coping skills for effectively managing emotions may have helped him to improve his mental health and reduce the harm he caused others. A common hurdle that arises for individuals with this disorder is low motivation to change in therapy. There is some hope that Anakin might have been motivated to change through his desire to connect with his children.

Status at Termination

When Vader revealed himself to Luke as his father, Luke rejected Vader and the dark side. Vader expressed sadness, not anger, over this. At a later meeting, Luke attempted to convince his father to abandon the dark side and join him, expressing that he sensed the light in his father. Vader told him that it is too late for him and turned Luke over to the Emperor. Through their interrogation of Luke, Vader learned he also had a daughter. The Emperor became angered and attacked Luke using his Force lightning capability. Unable to face this, Anakin attacked and killed the Emperor to save his son. At long last, Anakin fulfilled the destiny and returned balance to the Force. Anakin, knowing that he was dying, asked Luke to remove his helmet so he can see him with his own eyes. He told Luke that he was always right about the light in him and asked him to tell his sister as well. He then passed away peacefully, becoming one with the Force.


1. Was the portrayal of mental illness accurate?

Though it is unlikely that George Lucas purposely set out to portray Anakin as having narcissistic personality disorder, the depiction is nonetheless a fairly accurate representation of the disorder.

2. Was the character with mental health issues depicted with compassion?

It is our opinion that Anakin was portrayed as a sympathetic character despite his numerous problematic behaviors. The films tell the story of a boy with enormous talent who faces trauma after trauma and desperately tries to cope and protect his loved ones. He is preyed upon by Palpatine during an extremely vulnerable time and is ultimately unable to resist the dark side.

Overall ratingOn a rating scale from Youngling (least accurate and least compassionate) to Jedi Master (most accurate and most compassionate), we rate this portrayal of Anakin Skywalker as Jedi Master. For the reasons described above, we believe the depiction reflects an accurate representation of narcissistic personality disorder in a way that elicits sympathy despite Anakin’s wrongdoings.