The sound of death

Posted on August 17, 2013

When I started this blog, I had a vague idea of what I wanted: To share some of the knowledge collected over a lifetime with the readers, and maybe find others who wanted to do the same. I love to find and share post I find inspirational.

Suicide is a topic that never can be talked enough about. Psychologists in Norway are taught (but not enough) to ask questions related to killing yourself, and most luckily take this seriously. Most therapists will once in their lives lose a client (I am dreading when it happens to me) and it is a real trauma when and if it happens. I have talked with therapists who have lost somebody, and they never forget it. Considering how much I care for many of my patients, I know how much it would hurt if they were not here anymore, and I have seen and read enough to know that the pain never seizes completely. For this reason everything I learn that can make me a better therapist, is extremely valuable. For this reason, I want to share some interesting research I`ve stumbled into lately.

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In 2003, during his first year teaching at Harvard, Nock approached his colleague Mahzarin Banaji with a proposal. Banaji had helped develop the Implicit Association Test, which was introduced to social psychology five years earlier and has become famous for its ability to measure biases that subjects either don’t care to acknowledge or don’t realize they have on topics like race, sexuality, gender and age. Nock wondered if the I.A.T. could be configured to measure people’s bias for and against being alive and being dead, and Banaji thought it was worth a try. They experimented with several versions in Nock’s lab and at the psychiatric-emergency department at Mass General. Then they put their best one on a laptop and offered it to Mass General patients, many of whom had recently threatened or attempted suicide; 157 agreed to take it. Hunched in plastic waiting-room chairs or propped up in cots as they waited for a clinician to admit or discharge them, they were often grateful for a distraction.

Balancing the computer on their thighs, the patients held their pointer fingers over left and right keyboard keys. The heading “Life” appeared in the upper left corner of the screen, “Death” in the upper right. In the center, words associated with one of the headings popped up one at a time. Patients jabbed the left key to link “alive,” “survive,” “breathing,” “thrive” and “live” with “Life”; the right key matched “funeral,” “lifeless,” “die,” “deceased” and “suicide” with “Death.” The researchers asked the volunteers to do this as quickly as they could. Each word had a correct response. If patients put “thrive” with “Death,” for instance, a red X appeared, and the test paused until they hit the proper key. The sorting continued as the words reappeared randomly. After about a minute, the headers switched sides, and the process repeated. Then new rubrics popped up — “Me,” “Not Me” — along with new words to sort: “self,” “I,” “myself,” “my,” “mine,” “other,” “theirs,” “they,” “them,” “their.” Again the headers flipped places, and the sorting continued.

Once the patients had established a rhythm, the test began to measure bias. The headers doubled up: “Life” above “Me” and “Death” above “Not Me,” forcing test-takers to hit the same button to group “thrive” and “breathing” with “self,” “my” and “myself.” “Die” and “funeral” went with “theirs,” “they,” “them.” Theoretically, the faster the patients were and the fewer mistakes they made on this part of the test, the more they associated themselves with living.

Then “Life” and “Death” switched places, swapping the associations; the same key grouped “myself” and “my” with “funeral,” “suicide,” “die,” “deceased.” Agility on this part of the test would suggest an association with dying.

Doctors of all kinds, including psychologists, do no better than pure chance at predicting who will attempt suicide and who won’t. Their patients often lie about their feelings to avoid hospitalization. Many also appear to mislead by accident, not realizing they are a risk to themselves or realizing but not knowing how to say so. Some 90 percent of young people who kill themselves have visited their primary-care doctors within a year; nearly 40 percent of adults have within a month. The opportunity to help them seems enormous, if only there were a way to see past appearances and identify an inclination they might be hiding — perhaps even from themselves.

The Mass General patients and their clinicians rated on separate scales how likely they thought they were to try to kill themselves in the future. When researchers checked on each patient six months later, they discovered that, as expected, clinicians had fared no better than 50-50 in their predictions. Patients themselves, it turned out, were only slightly more accurate. The I.A.T., to everyone’s surprise, bested them both. People who sorted words more quickly when “Death” was paired with “Me” than with “Not Me” proved three times as likely to try to kill themselves as people who sorted words more quickly when “Life” was paired with “Me.” The I.A.T., it seemed, was picking up a heightened signal of suicidal tendencies that the most commonly used method for assessing risk — a clinical interview — had been powerless to detect.

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