Understanding suicide thjrough the eyes of a PHd who interviewed people less than 24 hours after they attempted suicide

I interviewed people less than 24 hours after they attempted suicide. Ask me anything- Tara De Liberto, PHd Psychology

For two years I worked on an NIH funded study at a major metropolitan general hospital before starting my PhD in psychology. Personal Blog: www.SwankPsych.com

What happens to someone after they attempt suicide? Are they forced to stay in a facility until they're deemed 'stable'?
It depends, actually. Many people make attempts that are not serious - especially as they can sometimes be very impulsive. A lot of people, for instance, drink heavily, periodically sink further into a depression, and decide to attempt quite suddenly without any type of preconceived plan.

If the attempts are not that serious and the person displays a will to live, commitment to outpatient treatment etc., the person is not forced into an inpatient treatment. In fact, people are more rarely forced into an inpatient treatment against their will (at least speaking from my experience in the U.S.). If the person is not in contact with reality however, and has psychotic features (e.g. they are hearing voices, think the TV is speaking to them), they are more likely to be held against their will for a period of time. If they also display distress at the suicide attempt failing, continued wish to die, have no support system, have access to lethal means (e.g. a gun), and an intent to re-attempt, they may also be mandated to stay. Do you believe it's ever the correct move to commit suicide?

Interesting question. I don't believe it is my right to tell anyone whether or not it is moral to take their lives. Especially if people are in unbearable emotional or physical pain, they should have the choice in continuing to live or dying. After all, none of us ever had a choice in being born in the first place.

Some of the stories I have heard from the people in the psychiatric emergency room are simply horrifying. From learning not only about the traumatic events people have experienced but their long-term every day repercussions, I can begin to understand why someone may chose to no longer live.

Ironically, as a therapist, I find having this stance is very beneficial. Understanding the client in this way without pretending to know what is moral fosters trust and strengths the relationship.

While the type of therapy I practice with people who are suicidal is certainly focused on keeping people alive with research validated techniques and methods, we have to respect a person's right to chose.

Were there specific reasons why they attempted suicide, or did they have a mental illness?

Rarely do people without a serious mental illness attempt to take their own lives. If my memory of statistics serves me well, about 90% of people who attempt suicide are diagnosed with a mental illness.

I interviewed about 60 people who attempted suicide w/in the past 24 hours and all had a mental illness.

One person, though, had a major depressive episode that was triggered after a specific incident involving the community placing blame on him after a death. While the patient had a history of depression, he was not currently experiencing depression before the incident.

In short, it is exceedingly rare to have a suicide attempt or completion without mental illness being present; however, some specific events can trigger an attempt, especially among people with mental illness.

After a suicide attempt, do people tend to recover from depression, or are they still miserable?

Depression may lift to some degree if the person has a lot social support after an attempt; however, this is not necessarily a good thing. After an attempt, getting the social support (that is usually much needed but never given) all of a sudden can actually reinforce suicidal behavior. Ideally, it is best to be there for the person, but gushing about how happy you are they are alive, you love them, and you couldn't live without them - especially if the person never hears loving things like this - could be trouble.

Concerning your question specifically though, I haven't really seen a marked decrease in depression after an attempt, per se. Actually, many people reattempt once they get out of the hospital. On the other hand, they're not necessarily unhappy to be alive either. Only two people I met expressed being truly upset to be alive. Of those two people, I think one really meant it.

Although it is quite disturbing to consider, the person who appeared to be truly distraught about surviving and attempt was a young woman with a long history of being repeatedly sexually abused by several male members of her immediate family. She saw no way out of the situation. How do you talk someone out of suicide? It must be hard!

I'm not necessarily in the business of talking people out of suicide, per se. I deal more with longterm treatment, but many therapists do get calls of people on the brink of an attempt.

There is an absolutely wonderful treatment called Dialectical Behavior Therapy (DBT) that has successfully treated people who have attempted suicide. There is a good crisis management protocol built into it.

The treatment involves contracting people for safety for various amounts of time. For example, I might ask a client to contract not to attempt suicide for just two months to give the treatment a chance. After all, the treatment won't work if you're dead.

Some clinicians have also come up with clever contingency plans. For instance, if you kill yourself, all your money will legally be donated to the Republican party. Also, while I realize that making suicide illegal may not make sense, the idea that if you kill yourself, your insurance money will not go to your family is also a more general - albeit clever - contingency plan.

Another more simple thing to do with people who are about to attempt is revisit reasons for living.

In general though, DBT involves teaching people to meditate and become more mindful of their thoughts, urges, and emotions. It incorporates some training in reasoning ability.

The treatment is structured in part like a class that teaches various skills in a group setting along with individual treatment.

Again, it is absolutely fabulous. There was an article about the inventor, Marsha Linehan, in the NYT this week: http://www.nytimes.com/2011/06/23/health/23lives.html?_r=1 Is there usually a "last straw" that puts people over the edge, or is it more gradual?

In my experience / opinion, there is no real last straw, per se. The vast majority of people who attempt suicide have a serious mental illness like borderline personality disorder or major depression. While it is true that suicide attempts are often preceded by a trigger, that immediate trigger is almost always nestled in a long history of a real struggle with regulating emotions, depression, anxiety, and/or addiction.

It should be noted though, I have obviously only had the experience of interviewing people who have survived suicide attempts - albeit, some very serious attempts with little chance of survival. Interestingly though, people who are most likely to die by suicide often have many previous suicide attempts in their past.

How long did each interview last?

The first interview was about an hour (then I followed up once or twice for less time).

I started off by asking participants basic questions and then would move into more personal territory.

After that, I administered what is called the Implicit Associations Test (IAT) - those of you who read Malcolm Gladwells' book, Blink, might be familiar with it. It is a reaction time test that measures how strongly you associate various stimuli presented on a computer screen. It is most famous for detecting racial biases. Check it out here: http://en.wikipedia.org/wiki/Implicit_Association_Test

For our purposes, we used the IAT to examine associations between words like "suicide" and "good" versus "bad." Roughly speaking, the more quickly people responded to "suicide" when it was paired with "good," the more likely they were to attempt suicide in the future.

In short, the computer test helps better predict who might attempt suicide once released from the hospital, which is unfortunately very difficult to do at the present moment. In fact, suicide rates are highest just after being released from the hospital.

If you're interested, results of the study were recently published in a paper I co-authored: http://pss.sagepub.com/content/21/4/511

There were also articles about this study in Science Daly: http://www.sciencedaily.com/releases/2010/07/100728111717.htm

and the Harvard Gazette: http://news.harvard.edu/gazette/story/2010/07/inklings-of-suicide/

What stops people from successfully committing suicide?

Sometimes alcohol, actually. Many attempts are committed under the influence of alcohol or drugs, and as such, one may not have the clarity of mind to successfully complete suicide. Even using firearms isn't 100% guaranteed to work, especially under the under the influence of alcohol.

While intoxication can prevent someone from carrying out an attempt to completion, many may not have a 100% will to die. Many people are apathetic and take a bunch of pills, for instance, not caring if they wake up or not. In fact, I would say that the vast majority of people I interviewed were apathetic about their attempt to some extent.

Also, some people may choose to abort their attempt, call a loved one, dial 911, or take themselves to a hospital. Perhaps a will to live prevents people from carrying out an attempt as well.

Other times, people intervene, much to the dismay of the person making the attempt. Other times the person who is attempting might feel relief or apathy if another person thwarts their attempt.

Of people who attempt suicide, what's the average number of total attempts?

This is actually a trickier question that it might seem.

Without taking into account the various ages of people in the study etc., I would say that of the people who I interviewed who made an attempt, they typically attempted 2 or maybe even 3 times beforehand (I was also interviewing people who hadn't just attempted).

But the best way to answer this question might be to look at a group of people who made attempts that have already died - both from suicide and not from suicide - and see how many total attempts they had while they were alive. I'm sure studies have looked at this, but can't recall the numbers off the top of my head (haha). I'll look it up & edit this post when I find the time.

How do they feel afterwards?

Only two people explicitly said they were upset that their attempt failed.

Of those two people, I am pretty certain that one meant it. The other seemed to have been attempting to garner social support rather than being 100% truly upset to be alive. (See the question: After a suicide attempt, do people tend to recover from depression, or are they still miserable?)

While the vast majority were certainly not thrilled to survive, they also did not report deeply wishing their attempt succeeded.

Also, I only remember two people particularly happy to be alive (and one was in the middle of a manic episode.)

Most people feel pretty low, unfortunately.

What were the primary ways people attempted suicide?

I saw a lot of different things, but probably the most common was pills. While I didn't see any attempts at hanging or sitting in garage with the car on, I saw several people who cut themselves - some tried on their arms while another person made a cut at the neck. I also met someone who walked into traffic and others who jumped off bridges.

What were some of the common patterns you noticed?

Interesting question. Since I interviewed almost 100 people for that study and remember practically every person very individually, there are so much rich qualitative and quantitative data to sift through. I'm sure we're going to be publishing results from this study for a while.

What the main data analyses showed though, was a 6 fold increase in the likelihood of making a suicide attempt after being released from the hospital if they scored in a certain range on a computer test we designed. This test- called the Implicit Associations Test - measures reaction time in milliseconds (so the test results cannot be deliberately manipulated) between words like "suicide" and positive adjectives like "good." It can be inferred that a relatively quicker response (in milliseconds) to "suicide" being paired with "good" versus "bad" indicates the participant's brain processes this association more quickly because that pathway is a road well traveled in the brain.

I wrote a little bit more about this in the post about how long each interview was. If you have any questions about this or my explanations are unclear, please let me know!

Does all this research into suicide and depression have an affect on you?

I was waiting for someone to ask me this! Thanks for asking.

It is almost impossible not to be emotionally moved when hearing people's life stories. After all, I'm a researcher not a robot. In the room, there is no question that I experience a whole range of emotions.

While this is true, I wouldn't consider this as having a negative effect on the whole. Sure, on a several occasions I left the psychiatric ER feeling pretty low or emotionally drained, but experiencing empathy or sadness isn't particularly damaging in itself. In fact, I find it has the opposite.

Whether or not I am exposed to the reality that people try to kill themselves, it exists. I find it much more fulfilling to play an active role in helping the problem.

On top of that, there is no question that I have learned skills from fantastic evidence-based & research supported treatments like Dialectical Behavior Therapy. I use these skills in some way every single day.

Did you ask suicide attemptors about the impact of their actions on people in their lives?

Actually, we did not ask about this in the particular study I was conducting; however, this is certainly an important topic that I would love to address here.

People who are not in the field often say "suicide is the most selfish thing you can do" and make comments on how people who attempt completely disregard the feelings of their loved ones. From my perspective, this statement reflects a deep misunderstanding of people who are suicidal.

First, many do not have family who are particularly supportive, which may be part of the problem in the first place. In fact, many times people who attempt suicide are surrounded by people who abuse them and see no other way out of the suffering.

And even if people who have attempted suicide do have people in their lives that are supportive, the person may be truly in so much psychological pain - e.g. they may be bombarded with flashbacks of a very traumatic event or paralyzed by depression - that it might be nearly impossible to take into consideration the perspective of a loved one.

Also, people who attempt suicide may feel so worthless that they think that ending their lives will actually be doing their loved ones a favor. Particularly if they are fixated on the idea that they are financially worth more dead than alive, they may try to kill themselves and make it look like an accident so the life insurance money goes to the family. But financial reasons aside, many people believe themselves to be a burden on their loved ones and want to take their lives to relieve their family of suffering. The reality of the situation is that in some situations the person may indeed be perceived as a burden to their family.

If you have a loved one who is chronically suicidal, a great resource is the book Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder.

Are you allowed to talk about this?

Haha, yes - as long as I don't give away any identifying information.

Do most people that attempt/commit suicide give recognizable 'signs'?

Also a very good question. While some 8th grade health classes will teach you that there are definite signs that people are planning to attempt suicide like giving away their belongings, it is not always this obvious. Some people may do things like this; however, many do not, especially if they are very serious about the attempt. According to people's reports, many did not tell a soul before the attempt and went through great lengths to conceal their plan. For example, people say may say they are going on business, will rent hotel rooms in places somewhat far from where they live, and attempt there. Others will go to parts of the city where they think no one will find them. On the other side of the coin, some people attempt very impulsively. They don't even have time to warn anyone or give away their belongings.

From a clinical standpoint though, we assess suicidality by examining the following: 1. desire people have to die 2. the intent they have to die(which is different than desire) 3. the degree to which they formed a plan 4. their number of past suicide attempts, 5. the reasons they have for living, 6. their access to lethal means, 7. their quality of their support network, 8. their plan for safety (i.e. going to the nearest emergency room if they feel suicidal.)

Looking at these pieces of the puzzle gives us a better idea of their likelihood for attempting.

What percentage of suicide attempts are caused by failed relationships or marriages

To be honest, I'm not so sure this question is as straightforward at it seems.

One of the hallmarks of both anxiety and depression is black & white thinking. For instance, if you broke up with your significant other and had thoughts/beliefs like: - I am unlovable - I will never be happy again - I am worthless without this person - I am a horrible person for treating my ex that way - No one will ever date me again

You certainly might be more prone to suicide than if you had thoughts/beliefs like: - Someone is bound to love me again - I will likely find happiness eventually, whether it be in a relationship or otherwise - I am a worthwhile person who is upset about this breakup - I feel badly about treating my ex the way that I did, but he/she will likely find someone else who treats them well and I will work harder in my next relationship to caring & faithful. Perhaps I didn't treat my ex well because we weren't a good fit. - Eventually, I will go on dates again

Again, the former set of thoughts characterize depression. Therefore, although the ending of a relationship might trigger a person to attempt, it really depends on how the person mentally processes the break up or divorce that is a real cause.

In addition to thought processes that might contribute to suicidality, intensely experiencing emotions and how people behaviorally deal with these emotions is extremely important as well.

For instance, some people may drink heavily and try to suppress their thoughts & emotions after a breakup. On the other hand, some may opt for more healthy choices of dealing with emotions like talking about the break-up with close friends, going to a cognitive-behavioral therapist, or focusing on their own lives. in short, ways of coping with intense emotion also contributes greatly to suicidality.

Within people who have depression, a fair percentage of people may report that the ending of a relationship is why they attempted suicide; however, the reality of the situation is that the picture is much more complex and involves: 1. black & white thinking 2. the degree to which people believe their dichotomous thoughts to be true 3. the intensity to which they experience negative emotions (which is effected by negative thinking and belief in negative thoughts) 4. how people cope with emotions

Therefore, in my opinion, if there are any studies reporting a percentage of people who attempted suicide because of a break-up, the results would not necessarily reflect reality.

With all of that being said though, I remember only a small number of people reporting relationships to be the primary trigger of an attempt.

What is the most common suicide attempt method?

Men typically attempt with more aggressive means like firearms, while women typically attempt with pills.

Why do people in Japan often commit suicides?

Although I only worked with people in America who are suicidal, I was involved with a World Health Organization project examining suicide rates in 27 countries while I was still primarily at Harvard University.

From what I remember, Japan was in the top five countries for highest suicide rate. Judging from the literature, unemployment, life hardship, and depression are the leading causes of depression in Japan.

While this is true, I would like to offer my personal thoughts on why this may be the case here. Because unemployment rates are higher and conditions worse in other countries with lower suicide rates, there need to be other contributing factors.

I would say the culture in Japan around honor may significantly contribute. While honor is a useful value in some cases - for instance, it may drive success - placing a lot of importance of the judgments of others has a dark side. In the case of unemployment, many times forces outside of one's control cause job loss. Nevertheless, this may cause intense (& undeserved) feelings of shame. Shame is intimately linked with the idea that one is worthless, a theme that practically defines depression. When combined with hopelessness about the future, feelings of worthlessness seem to drive suicidal behavior.

In short, I think the high value placed on honor, which may have side effects of shame yoked with feelings of worthlessness and hopelessness, may be part of the story behind s

suicide in Japan specifically.

Are you published?

In fact, I am. I listed a bunch of published work along with some other thoughts on my blog: http://taradeliberto.blogspot.com/

D Why does the gov. feel its okay to involuntarily admit suicidal people, when killing yourself is not a crime?

Although suicide is not technically illegal, it is still considered a common law crime in many states.

In terms of involuntary admission, there are a few important points to note. First, it is worth noting that when people are suicidal, they can be dangerous to others as well. There are many many cases of murder suicides (e.g. Columbine). Second, as previously mentioned elsewhere on this thread, many people are happy to be alive following an attempt. Many attempts are made impulsively under the influence in highly emotional states. Even though it is not technically illegal, I definitely agree involuntarily admitting people, which may surprise some of my friends. While I believe it is a person's right to chose, many times people are not making a decision from a what can be considered a highly emotional and irrational state that is transient.

How can I read your personal blog? It seemed to mark private.

I am keeping the one listed above private for a couple weeks because it is under construction, but it should be back up soon! Thanks for trying to check it out.

If you want, you can visit my academic blog at http://taradeliberto.blogspot.com/

Is money (financial position) an important reason for those who do suiside?

It certainly can be; however, the degree to which financial problems influence suicidality is likely very tied to how strongly the individual person links their self-worth with money.

For instance, if you are particularly enterprising and derive the majority of your self-worth from acquiring wealth, then you would be more at risk. On the contrary, Buddhist monks are not likely to be particularly inclined to kill themselves if they find their bank accounts dwindling.

I actually wrote a blog post a while ago about how the individual's personal valuation of money is neglected in the academic literature despite its obvious importance. I titled it Monks and Money: http://taradeliberto.blogspot.com/2010/05/how-we-value-money.html

What is the most common misconception about suicide?

I think the most common misconception about suicide is that it is selfish.

People who are not suicidal typically have a very hard time understanding why someone would want to die. Broadly speaking, those who have never been suicidal usually have people in their lives who love them and they love in return. They know they will be missed sorely if they died and could never imagine taking their own lives as it would hurt others so much.

In my experience, people who are suicidal are usually in much more complicated scenarios. This is certainly not to say, however, that if people who are suicidal kill themselves that they will not be missed. The vast majority of people who are suicidal have loved ones who would be deeply hurt by their loss. Although this is the case, the abuse many suicidal people have endured from their loved ones makes their comprehension of their own importance to the people in their lives understandably cloudy.

If you were directly and indirectly told by your mother, for instance, that you were worthless and unlovable, would you feel obligated to keep yourself alive for her? Would you have trouble believing that other significant people in your life love you? If you weren't actually sure if other people loved you, would you subject yourself to a lifetime of constant emotional or physical suffering by continuing to live for their sake?

The majority of people who are suicidal come to believe, through a variety of routes, that they really are worthless and unlovable. When someone truly believes they are worthless and unlovable at the core, all sorts of other thoughts come up that constantly bombard their daily consciousness. For instance, they might think they have nothing to contribute, their mere existence depletes resources for other people who matter, they are a burden to other people, and everyone would be better off without them. So now consider this: if you had these thoughts, would it be selfish to kill yourself? In my experience, people who are suicidal do not perceive they have many reasons to live. Upon further exploration into their histories, it becomes clear how they arrived at their current conclusions. Deeming suicide as selfish simply reflects a judgment from ignorance. Tweet | Like U 3 D What is the main reason according to you coz of which people are committing suicides.?? There is a very complicated answer to your question. There are many important factors at play including history, genetics, physiology, style of thinking, trauma, current life circumstance, religiosity, available support systems, impulsiveness, and access to lethal means - just to name a few. For each individual person, some or all of these factors combine to various degrees, to put a person in a position of immense emotional pain. At the time people attempt, they are typically typically hopeless about the future and see no way out of their suffering other than death. Tweet | Like U 3 D how do you distinguish people who really wanna stop living and people who just want some suicide act?

This is such an important question. Some people will say they made an "attempt" although they really had zero intent to die. For example, they will take a bunch of pills knowing there is no way it could kill them. If one leads someone else to believe they intended to kill themselves without having any intent to die, we technically call that a suicide gesture.

Classifying these behaviors can get tricky because many people who make suicide gestures may have suicidal thoughts and even want to die. Although it is difficult, it is really important for both clinical and research purposes to inquire about the intent and function of the suicidal behavior. The suicide literature is inconsistent with their definitions, especially in the U.K. where researchers lump suicide gestures in with non-suicidal self-injury (i.e. cutting one's own skin without intent to die). While self-injury is by definition not suicidal, the function of that behavior is rarely to make others believe you want to kill yourself. Not making the distinction in research can lead to results that are less than useful.

If you're interested more in self-injury specifically, check out my other thread here: http://www.anyasq.com/54-i-research-people-who-cut-themselves

I also wrote a blog post about why people cut themselves that has become pretty popular: http://taradeliberto.blogspot.com/2011/02/why-do-people-cut-themselves.html

How you did this ? Is it possible to do by a normal human ?

Sorry - can you repeat the question (lol)? In the declaration of independence it says"life..pursuit of happiness." so if suicide makes you 'happy'. y involuntary?

Interesting question! So sorry for the delay - I've been so backed up with deadlines for a new study. I'll likely update this answer, but I'll go ahead and publish something on the site for now.

I'll start by addressing the question of legality of suicide. Although I first thought suicide shouldn't be illegal, after working in the field, I have come to understand why it is considered a common law crime in many states. Contingencies are very important in the treatment of suicidal behavior. Deeming something illegal or immoral is a very useful strategy as it keeps someone alive long enough for them to receive the proper help that they need. It is likely the case that an acutely suicidal person is extremely emotional and irrational at the time they are considering suicide (although this isn't always the case). It is important to have rules in place to keep the persona alive long enough for them to either settle down emotionally or seek treatment. As I've mentioned before, Dialectical Behavior Therapy (DBT) has really been shown to be effective for treating suicidal thoughts and behaviors. I'm in the process of co-authoring a paper with Dr. Matthew Nock (who as mentioned before, is a winner of a 2011 MacArthur Fellowship, commonly known as the Genius Award) about the efficacy of DBT. It should be submitted in a couple of months.

Do you think our gov. funded psych centers are adequately taken care of? Should the centers be more 'plush'?

Although there is always room for improvement, the current facilities have certainly come a long way! The conditions are certainly adequate from what I've seen.

Psych patients have a tendency to be abused in a sense and our merely looked at no dif. than a criminal. true?

Abused? No, I don't think so. The facilities I have worked in certainly don't abuse suicidal people.

Perhaps the public's stigma, attitudes, and behaviors towards people who are suicidal can be considered abusive, but certainly not among mental health professionals!

How many were voluntarily admitting themselves vs. Involuntarily admitting?

Off the top of my head, the vast majority were voluntary. Only a select handful were involuntary - at least out of the people who agreed to participate in our study.

Had any of those you interviewed previously been pyschiatrically hospitalized? How do they feel about psych hospitals?

Oh yes. Many. In fact, several people were enrolled in the study multiple times by accident (which we accounted for in our analyses) because they were "frequent flyers" in the psychiatric ER. Many of the people I saw were used to being in "psych hospitals" per se, but on psychiatric units in hospitals.

How many people that you interviewed had previous suicide attempts? If so,were they hospitalized?

Of the people who I interviewed who attempted, the majority had previous suicide attempts. Only a few were attempting for the first time.

It should be noted, that if people "fail" the at a suicide attempt first couple of times around, it resoundingly does NOT mean that they are at lesser risk for dying by suicide. It is the complete opposite - the more someone attempts, the more likely they are to die by suicide.

I've really heard the joke from people not in the field "wow, that person even failed at killing themselves!" more times than I can out. For the record, I really have very strong negative reactions to this!! First, as a comedy fan, the joke is beyond hack. Second, it is extremely condescending and seriously misinformed. Again, the more someone attempts, the more at-risk the person is.

Do you believe/think that our mental health system in our country helps people or merely keeps them 'safe'? (psych hosp)

Although it depends on the severity of the case, I really must stress that a great many people are immensely helped by mental health workers, especially those practicing treatments supported by research like Cognitive-Behavior Therapy (CBT). Almost by definition, the vast majority of people aren't very severe. It is these people that need a case management approach (i.e. just making sure they are doing the bare minimum to take care of themselves and their affairs). On the other hand, hospital & outpatient workers have been shown to really make a difference.

What did you asked to them ?

I mainly asked them about the reasons they attempted, how they attempted, how many times they've attempted, the methods they used, and general questions about the state of their mental health.

After that I administered a computer task that I mentioned above.

Thanks for asking!

What will be your words if I'm going to suicide?

If you're seriously considering suicide, you should seek out a professional or go to your nearest emergency room. The best treatments around for suicidal tendencies are Dialectical Behavior Therapy and Cognitive Behavior Therapy. I highly suggest seeing a therapist who is highly trained and specialized in one of these two ares.

D What are your thoughts on EFT in treating depression and/or suicidal tendencies?

From what I understand, Emotional Freedom Technique involves the use of acupuncture.

I managed a study on the physiology of self-injury that will hopefully be published soon. The results of this study indicate that the body becomes much less anxious when the skin is intentionally cut under certain conditions (see my self-injury thread on AnyAsq for more info).

Perhaps acupuncture may work similarly to self-injury on a much smaller scale in without impulsiveness; however, at this current moment in time without knowing much about EFT, I am taking the stance that learning to manage emotions with psychological skills is where the vast majority of one's efforts would be best focused.

how do you validate he claim that someone attempted suicide /is suicidal?

Commonly, we employed two methods: 1) checking the urine and blood serum toxicology report so we would know if someone actually took a large number of pills and 2) if they attempted to injure themselves with a sharp object or weapon, visible wounds were noted. We were also sure to note the difference between an aborted suicide attempt (e.g. standing on the edge of a bridge but then deciding not to jump) and an actual attempt (e.g. the person jumped but survived). Additionally, interrupted suicide attempts were noted (e.g. the police stopped the person from jumping).

Have you seen Mathew Nock's work (2011 MacArthur Fellowship Award winner)? How does Nock's work relate to your work?

Haha - yes, in fact Matt was the principle investigator on the study this thread is about. For those of you who may not know the MacArthur Fellowship by its formal name, it is more commonly referred to as the Genius Award. We're all very proud now that he has been publicly deemed a genius. No surprise, though.

I worked for several years as his senior laboratory manager and we still collaborate on research together. Everything I've published so far has been with him. Something that might be interested to the readers here - Matt & I co-authored the chapter in the Diagnostic and Statistical Manual's Casebook on self-injury together (e.g. cutting one's skin w/o wanting to die). Therefore, to date, my work is his work. I'll be submitting my first publication without him in the coming weeks on disordered eating. Finally branching out!

How you did this ? Is it possible to do by a normal human ? :p

If you're asking how I emotionally dealt with repeatedly interviewing people after they made attempts on their lives, the short answer is simply that one naturally becomes habituated to certain experiences over time. I talk about this more in other posts, but I was certainly more moved in the beginning by this work. Eventually it got to the point where only a really striking story would have the same impact on me as when I started.

Do most insurance companies deny payment of life insurance benefits to the surviving family members?

If I'm not mistaken, I think that they all do but there are some stipulations. For instance, if you have only had your plan for 2 years, they will not pay, but they may pay after that. Interestingly, this fact can be used in treatment as a deterrent.