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.
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.”