Disinfo Contributor and Author Peter Bebergal on His Brother’s Suicide

Picture: Peter Bebergal (C)

DisinfoCast guest and Disinfo.com contributor Peter Bebergal (Too Much to Dream) wrote an article a few years back about his brother Eric’s suicide and research into the experimental application of the Implicit Association Test in ascertaining suicidal intent. It’s a great read, and with two recent posts about suicide, one that might intrigue our readers.

Here’s an excerpt (mid-article):

What clinicians need is some other measure beyond external evidence that could assess whether someone like Eric is capable of suicide in the near future. Four years after my brother’s death, Harvard researchers at MGH are experimenting with a test they think could help clinicians determine just that. It focuses on a patient’s subconscious thoughts, and if it can be perfected, these researchers say it could give hospitals more of a legal basis for admitting suicidal patients.

Of course, I can’t help thinking about whether such a test could have saved my brother. But I also wonder: Would it have been ethically right – or even possible – to save him even if he didn’t want to save himself?

THIS MISSING PIECE in the suicidal puzzle is what prompted the innovative research study now in its final phase at MGH. The study, led by Dr. Matthew Nock, an associate professor in the psychology department at Harvard University, is called the Suicide Implicit Association Test. It’s a variation of the Implicit Association Test, or IAT, which was invented by Anthony Greenwald at the University of Washington and “co-developed” by Dr. Mahzarin Banaji, now a psychology professor at Harvard who works a few floors above Nock on campus. The premise is that test takers, by associating positive and negative words with certain images (or words) – for example, connecting the word “wonderful” with a grouping that contains the word “good” and a picture of a EuropeanAmerican – reveal their unconscious, or implicit, thoughts. The critical factor in the test is not the associations themselves, but the relative speed at which those connections are made. (If you’re curious, take a sample IAT test online at implicit.harvard.edu/implicit/.)

The IAT itself is not new – it was created in 1998 – and has been used to evaluate unconscious bias against African-Americans, Arabs, fat people, and Judaism. But critics question whether the test is actually practical, and up until now no one has tried to apply it to suicide prevention. As part of his training, Nock worked extensively with adolescent self-injurers – self-injury, such as cutting and burning, is an important coping method for those who engage in it, though they are often unlikely to acknowledge it. Nock thought that the IAT could serve as a behavioral measure of who is a self-injurer and whether such a person was in danger of continuing the behavior, even after treatment. In their first major study, Nock and Banaji asserted that the IAT could be adapted to show who was inclined to be self-injurious and who was not. And more important, they said, the test could reveal who was in danger of future self-injury.

The next step, Nock realized, was to use the test to determine, from a person’s implicit thoughts, whether someone who had prior suicidal behavior was likely to continue to be suicidal. It would give doctors a third component, along with self-reporting and clinician reporting, and result in a more complete picture of a patient. Nock doesn’t assume that a test like the IAT would be 100 percent accurate, but he believes it would have predictive ability. “It is not a lie detector,” he says. “But in an ideal situation, a clinician who is struggling with a decision to admit a potentially suicidal patient to the hospital, or with an equally difficult decision to discharge a patient from the hospital following a potentially lethal suicide attempt, the IAT could provide additional information about whether the clinician should admit or keep that patient in the hospital.”

Keep reading at Boston.com.

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  • Liam_McGonagle

    Mr. Bebergal obviously still grieves the loss of his brother, as I think most decent people would. But I still think we need to consider refusal to participate in the world as our most basic freedom, one that should not be denied lightly.

    Survivors are haunted by such an event for the rest of their lives. It presents a series of grave questions that can never adequately be resolved: “Could I have done something differently to prevent my loved one’s death?” “Was my loved one’s act a judgment upon me?” “Am I a horrible person?” “How can I make sense of my loved one’s death in terms of my own experience?”

    But that’s kind of the point: it’s not always about YOUR experience.

    Suicide is always tragic because it is an unequivocal rejection of what we are brought up to believe is the fundamental good: Life. But at root it’s a refusal of the suicide to go on living in a world not of his/her own making–not a forcible usurpation of the choice to live from others. It is the ultimate act of an individual’s free will. Grieving is inevitably prolonged and intensified under such conditions, but it does rather obscure from us the possibility that we do not possess the right to omnipotently control others.

    Yes, I’m aware of the arguments–mental incapacity, permanent solution to a temporary problem, etc., etc. I’m sure that quite often, maybe even most of the time that those arguments are true. Perhaps true, but completely unprovable, since they all rely on some type of counter-factual analysis which by its very nature involves a strong element of speculative, unrealistic wish fulfillment and fantasy.

    I’ve had friends commit suicide over the years. I’ve seen how the event affects families, friends, significant others. I’ve participated in the post-event rounds of grief, recrimination and self-recrimination. I, too, have wondered, in vain, how a person of superior merit of every kind, spiritual, social, intellectual, etc. can find Life so barren a prospect as to think it no longer worth the struggle.

    But at various points, for various reasons, I, too, have considered suicide. There have been times when the situation appeared so hopeless that I felt I could not go on. Let me tell you, though, that the thought that I could be forcibly prevented from carrying out the act was no solace. Indeed, I regard this theft of choice with a repugnance equal to the notion that there is an Invisible Sky Daddy who imposes unspeakably vile punishments for all eternity on those who refuse to passively play their part in some barbaric, Bronze-Age racial myth.

    In fact, the thought that suicide was still an option available to me, my last inalienable right and human dignity, was probably the only thing that carried me forward until better times.

    • Calypso_1

      What you regard as theft of choice might for others simply be a bestowal of more time and perspective from which you might continue your experience before its finality becomes inevitable.

      As for me, I promised myself that I would indeed die someday. Death, I have no doubt, will oblige
      me of this wish. The ensuing delay between that initial impulse and its irrevocable outcome has and will continue to provide many moments in which to attempt as noble if less dramatic impulses
      of will & personal dignity.

      • Liam_McGonagle

        I can’t speak for every last man/woman on earth, but I think we should each take exactly as long as we want to make that decision and not one second longer. That’s what “choice” means to me.

        But I understand your perspective. If memory serves, you’re a medico, bound by oath and professional reputation to observe society’s consensus view as to the value of every human life–which generally means spare no expense, pain or indignity to preserve certain biostatistics, even in the face of the patient’s own evaluation of life quality or extremely improbable recovery. That’s the professional contract, and you cannot disregard it lightly.

  • DeepCough

    “the Implicit Association Test, or IAT, which was invented by Anthony
    Greenwald at the University of Washington and “co-developed” by Dr.
    Mahzarin Banaji, now a psychology professor at Harvard who works a few
    floors above Nock on campus. The premise is that test takers, by
    associating positive and negative words with certain images (or words) –
    for example, connecting the word “wonderful” with a grouping that
    contains the word “good” and a picture of a EuropeanAmerican – reveal
    their unconscious, or implicit, thoughts.”

    Doesn’t this remind you of the Empathy Test from Blade Runner?

    • Matt Staggs

      “You’re watching television. Suddenly you realize there’s a wasp crawling on your arm…”