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Dr. Don Welch:
Welcome to My Therapist Sez, an interactive experience in reaching your most important relationships. I’ll be your host and moderator as we present dealing with suicide. Suicide is a very painful and delicate topic. We need answers to managing suicidal thoughts, decreasing depressive moments, and dealing with depression and anxiety that can overwhelm a person. What should I do if a loved one, a friend, or a colleague show signs of wanting to harm him or herself or end their life?
This and other questions will be addressed during today’s My Therapist Sez broadcast. In a few moments, Dr. Julie Hayden will provide a brief presentation about suicide prevention. She and I will address your questions while hopefully providing you tools to help those in need. Dr. Hayden is a regular presenter on this broadcast, and is a licensed psychologist, Chief Academic Officer at Rhombus University and clinical director at Genesis Recovery San Diego.
Today’s event takes place before a live audience and live streaming while offering practical, biblical and scientific solutions. It’s like having your own Christian mental health relationship doctor within the comforts of your living room. I hope you will sit back, relax, and take in these life-changing insights. Please join me as we connect with a live audience in My Therapist Sez.
Welcome to My Therapist Sez, and we are so pleased to have Dr. Julie Hayden with us this evening who has been a regular speaker with us over these many years. Without any further introduction, I would like to ask her now to begin her presentation, and then following that, we will have our lengthy discussion with your questions leading the way. Would you join me in welcoming Dr. Julie Hayden?
Dr. Julie Hayden:
Thank you. I’m very excited to be here today, and especially to discuss this topic with you, answer questions, cast a picture of what you might be able to learn and understand to help prevent suicide. Before we even get into the topic much, I think it’s helpful to understand though, we are studying and finding patterns, and ways to intervene, but in a big picture we can’t do well at predicting and preventing suicide.
In the big picture, there’s people that will follow through when we would not have guessed it, and those who seemed very at risk, that never followed through. It’s a very complicated topic. I think that’s important to start with, because you have to be careful what you hold on your shoulders as far as responsibility and what cannot be on your shoulders. We’re going to look at a biblical worldview as we start anyways, but that’ll help us remember what is God’s part in this, because it’s much bigger, much heavier than what we can hold.
Then our part, what we can do in context of this to help fight a battle that sometimes is very overwhelming. Let’s just get a biblical context as we dive into more content and statistics. I just want to remind you, the reason we have some of these difficulties, why we have depression, why we have anxiety, why we have people wanting to end their life for various reasons. In the big picture, we started perfect. We started creative perfect, perfect relationship with Adam and Eve, and relationship with God.
When the fall happened, when Adam sinned, and the consequences of sin came down, then you have a list of curses and everything falling apart. So within context of that, sin corrupted that perfection and now we live in a curse world. Now we live with consequences in our biology, in our relationships, we see this everywhere. Now we live a human experience that involves suffering, and tragedy, and evil as well as good and hope for the future.
We know if you follow scripture all the way through, there’s hope. There’s hope for the future, there’s hope for restoration, our relationship with God as well as others, and hope for perfection eventually again in heaven hope in the future. In context of all of that, this is our human experience, to deal with suffering, to deal with people’s pain sometimes. You may be that compassionate person to be right with somebody in their pain.
We’ll move forward and we’ll look at, at statistics. One of the reasons why we’re going to look at some of the details both in statistics currently with suicide as well as what to watch for is because there’s patterns. So remember, we can’t actually do a great job all the time guessing what’s going to happen, but we do see patterns. You can see them as data points. If you’re going to be worried about a person, you get a couple data points, “He’s a little concerned.”
As you go through these, if you get a lot of data points, a lot of the risk factors are there, you need to do something fast and we’ll talk about what that looks like and what you can do. So that’s even what counselors use. You’re always careful, you’re always doing the best you can and yet if there’s a lot of risk factors in one person, you’re going to find someway to intervene quickly.
So that’s what we’re going to be looking for. Let’s look at the broad scope. In 2015, suicide was the tenth leading cause of death in the US. Over 44,000 Americans died by suicide each year. We’re going to move through some of these pretty quick the slides. The suicide rate in the state of California, 10.7 per a hundred thousand. That was in 2015. National average is 12.93 per a hundred thousand. San Diego County, 13.8 per a hundred thousand in 2018. We had 458, I believe that was 2018.
Now, you might not be able to see this up closely although we could get you access to this so you could or you could look it up. Basically, what this is looking at is causes for death and the yellow are by suicide. You can see it’s number two in a lot of age categories. It’s pretty up there as far as reasons that people would have non-natural deaths in San Diego County. This is from 2003 to 2012. So very specific for you here, but online, people watching you can also see the statistics by each county.
Keep going here. Suicide outnumbers homicides three to one. So this is something that’s just growing, it’s huge. We’ll look in a moment, there was a decline in suicides and were starting to increase now. So we want to watch that. When you’re looking at gender, more females and males attempt suicide, and more males complete suicide. These are patterns that have been pretty stable for a long period of time. There’s various ideas as to why.
We’re going to look at risk factors. These are the data points I was telling you about. This is what I wanted you to watch for, but how we’ll define risk factors. They’re factors that make it more likely that an individual will be at risk for suicide. They’re biological, psychological, social, individual. We’re going to break them down into categories and go through each. This is what you’re listening for. This is what you’re watching for. Let’s take a look at some of them.
Bio-psycho-social risk factors. Mental illness, and in some of these you’ll see in multiple categories, know that that’s a big deal. These are consistent risk patterns. If you see it multiple times, help that pay attention in your mind and stick, because it’s really important. So mental illness, 90% of suicides, the people that are completing suicides have mental illness of some sort, maybe undiagnosed but you can see that in their patterns that they would line up as having some mental health difficulty.
Substance abuse is huge, 50 to 70%. Hopelessness, and we’ll look at this, but one thing to understand about suicide too is many times, a person sees it as a solution, a conclusion that they don’t see any other option to end what they don’t want right at that current moment. We’re going to look at that in the future, because it doesn’t always last. Sometimes it does, but sometimes it’s a moment, and that’s why we can’t always predict it. All of a sudden it’s a moment, and they think this is the answer. So because of that, sometimes you’re just delaying. Well, don’t do it right now, because that gives you a fighting chance to intervene later. We’ll look at that in a moment as well.
Impulsive-aggressive behavior. History of trauma, maybe childhood trauma. Physical illness, previous suicide attempts. So if somebody has had a previous suicide attempt, they’re more likely to complete a suicide as well and have another attempt. Age, gender, race which we’ll look at and exposure to complete a suicide. So maybe in their family, other family members have committed suicide. We’ll keep going with environmental risk factors. Job and financial loss, loss of relationships, social loss, easy access to lethal means. We’ll look at this, but if they are telling you how they would do it and they have access, that’s a big red flag. Somebody needs to intervene quick.
There’s copycat type factor in teens sometimes. So if they’re already dealing with depression or identity struggles, and one person tries to commit suicide in their social group, sometimes you’ll see multiple other teens try to commit suicide or at least act out that behavior. Incarceration is the third leading cause of death in jail or prison, and barriers to accessing treatment. So if they wanted to get help for some reason, there’s a barrier there.
Special populations, and here’s where you see some overlap. Again, mental illness. So those who struggle with schizophrenia, bipolar, some of these other mental health difficulties, they’re going to be at higher risk for suicide. The LGBTQ community, autism, substance users, trauma survivors, inmates, and first responders. So interesting, those who are helping people in the middle of their crisis, they’re at risk for suicide attempts. So good to know. Of course, veterans.
We’ve really dealt with this in San Diego. There’s a lot of veterans that have attempted suicide. This has been an increase and committed suicide. So this is a huge factor where you’re dealing with currently and across other states as well.
Now, if you can see this, it’s looking at age, but again, we’re looking for data points. Everybody could be at risk. This is something that could come to any person of any race or nationality of any age or gender. At the same time, we see patterns. So we can look to see the age and see who’s at the highest risk of suicide. So you can see here male and female. You can just notice those who are at the highest risk.
For women actually around 41 would be a risky timeframe. For men, it’s going to be those that are over 71. The older generation for men is a very high risk population. Suicide risk in teens. This is a little hard to see, and I want to get to some good information, so I’m going to skip it, but if you go and you’ll look on the power point later, you can get some of that data. It’s gone down, and then started to go back up.
Then ethnicity. So if you’re looking at statistics here, you can definitely highlight the one that’s both the highest in women and men is the Native American population. So there’s lots of reasons for this, but that’s a very high risk population. Again, you’re looking for data points. If you see somebody in this category, they’re an older male, they come from this background, and they have a mental illness, these points are increased, it’s going to be something you want to find help for this person.
Let’s keep going. Warning signs, observable signs that it can flash in your mind, “Something’s going on.” Let’s see what they are. Verbal, if somebody is talking about wanting to die or killing themselves, people do this. So just listening. Sometimes people don’t take them serious. So I wish I were dead. I’m going to kill myself. Talking about feelings of hopelessness or there’s no reason to live. There’s also indirect. People will be better off without me. You won’t have to worry about me much longer. I feel like there’s no way out.
There’s these ways of expressing it that might not be direct, but it’s obvious they don’t want to be here. Hopelessness, withdrawing and isolating, increasing the use of alcohol or drugs, acting anxious, agitated, behaving recklessly, these could all be signs. Looking for a way to kill themselves. In the Google search engine, you’d be surprised, that’s a different statistic I don’t have quickly, but the statistics on what’s typed in Google, this is actually pretty high. It’s sad. So search history.
Putting their affairs in order, organizing, who’s in-charge of their will, their executor, just trying to organize and plan things. I had one person that she was trying to make sure somebody could prepare her kids close because it was just something specific in her mind. She was telling somebody that if they could prepare her kids’ clothes. She was ready. She was at the end, and she was trying to get everything in place for her kids. Giving away prized possessions. Displaying extreme mood swings, changes in eating and sleep patterns, which this would be more connected with depression also.
Let’s keep going. I want to get to a couple of the things you can actually do. We’re going to skip this one. We’ll come back to some of it. Broadly, what we’re going to do now is look at how you assess a risk, minimize risk factors, and then maximize protective factors. This is where you might come in if you’re a family or a friend, how can you increase hope. How can you build in ways that they don’t want to continue with this.
So in a broad sense, you’re going to want to build a relationship. You might already have one. You want to connect. They want to isolate. The depression may be increasing and they just want to hide. Here’s something to stick in your mind a little bit more concretely. Sometimes they’re so depressed they have no energy to do anything about it. As they start feeling a little better, they get energy and that’s one of the highest risk timeframes, because they have enough energy to complete it.
When they’re very depressed, they made a conclusion in their mind, “This is the only way.” It’s a solution. They don’t see any other option, but they have no energy. As they gain energy, it looks like they’re doing better, but actually that’s one of the highest risky timeframes for a person to complete the suicide. So you want to watch for that. You want to ask them questions, “Are you thinking about suicide? Have you thought about hurting yourself? Have you ever thought about killing yourself?”
This may seem extreme, but what they found broadly is direct questions work better. So just ask them directly. What you really want to do, I probably have this somewhere in there, but while I have it in my mind, you want to say, “Have you thought about how? Do you have a plan?” Because if they have a plan, that’s one of the highest risk situations as well. So if all these things you see, and they have a plan, they know how they would do it, and definitely they have access to it.
So if they say, “I would just want to shoot myself,” but they have no guns and they don’t have access to guns versus you know they have six guns under their bed and they’re saying that this is how they would do it. So these are the types of data points you’re looking for that you would want to do something quickly. So you’re connecting, you’re giving plenty of time, like you don’t want to rush, you don’t want to allow them to isolate. So you’re spending time talking with them.
You want to help them feel normal. Many people go through this. Many people have struggles with depression and it may feel like that’s the only way out, but it’s not true. There’s hope in the future. You may not have it now, but I have it. I’m on the outside. I see hope. I know this is going to get better. So you’re trying to encourage them that you have hope, and you’re just basically dragging this out. You want them to stay connected, not be alone with their own thoughts at that point.
You want to avoid yes or no questions, and have open-ended questions. Just keep them talking. Keep them talking and trying to gear them to anything that you can see that would allow them to gain a little bit of hope for the future, and just letting them speak to you, letting them have that connection. Then you want to be ready with resources. So we can talk about this maybe as we have question/answer time. If you can know who to go to if they’re ready for help, that’s going to be huge, because it may not be you.
So you can build a relationship, allow them to just share, and don’t stop conversation. Be careful not to jump in and say, “That’s not true, God does love you.” It was like, “Yes, He does,” but you don’t have to feel like you have to counter everything they’re saying. Let them vent. Let them get it out, validate them, “Yeah, it sounds like you’re going through so much. It seems so difficult. I know you have no hope, and that’s okay, I have hope. I believe you’re going to get it soon. We’re going to find something.”
For time sake, I’m going to jump to one really important one is any leverage you know. Usually, somebody has something. Their kids, some person in their life where even their relationship with God where it keeps them from committing suicide, and they’ll express it. Grab it. If they say, “God will be so mad at me.” “Well, I don’t know if He would, but I know He wants you to be alive right now.”
“My kids, maybe they will be better off without me.” “I doubt it. Kids need parents. Bottom line. I don’t care how you think you are at parenting. They need you. It would matter. It will be a big deal.” So you emphasize whatever leverage you have, whatever they care about that’s keeping them here, make it big. Increase it. So there is a lot more we can go into, but that just gives you a broad picture of the important things to watch.
Then in so many times, it’s catching it and getting them to communicate and then connecting them to resources. Any way that they could feel like there’s something valuable out of their life right now. So your friendship may be it for now. So those are the things that you can do. Otherwise, getting them to other resources is one of your main goals, and knowing that ahead of time, so it’s fast when you have that moment.
We’ll use the rest of the time more to open it up for discussion and get some of the questions addressed, and then we can always come back. If you see something on the power point you really want me to address, go ahead and come back. Actually, these ones we’re saying, “Studies have shown that although previous suicide attempts are a risk factor, 90 to 93% of people who attempt suicide, who have attempted to suicide do not die by suicide.” That’s great to know. That just gives us hope.
Yes, it’s a risk factor, but we have plenty that are not committing suicide that we catch after they’ve attempted and they are able to come out of that and not complete it. We can leave those up just for a moment, and then you probably have access to this as well, but knowing your crisis and access line is really important. 24/7 they can call anytime. If it’s not San Diego, every county has some resource usually. Find out what it is so you have it ready on your phone, the minute they want to talk to somebody, get somebody on the phone for them, okay? Thank you.
Thank you. Thank you very much. Dr. Julie Hayden. Could we move back to the previous slide there and talk about that for just a moment. I have two questions already. If you have a question, please write it down, hold it up in the air and bring it to us if you would. In this, there’s couple cards right here. Studies have shown that although previous suicide attempts are at risk factor, 90 to 93% of people who attempt suicide do not die by suicide. Let’s talk about that for just a moment, because that does give us a bit of hope in the midst of a very, very difficult. Help us to understand why that is true.
Sure. There’s many reasons, but a couple, one is sometimes when people are having this behavior of a suicide attempt, there’s a range. One, they may not be good at it basically. So whatever they’re doing, their method they’re using is not lethal. So it is a suicide attempt, but whether it’s not lethal or somebody catches it, they get them to the hospital fast, and they get them help, they don’t complete. So then, a lot of times obviously it’s much more known to everybody what’s going on and they get help.
So they’re either not going to have another attempt, or if they do, it’s still not a completion, because we do see that trend that there might be an increase. People might try to commit suicide several times and not complete it. So it could be that they are not using a means that’s lethal. That’s one thing that you see the difference between men and women, a lot of times the methods used by women may not kill them, but men tend to have methods that are very dangerous. So you’ll see the completion on the men’s side increasing. So that’s interesting.
There’s also a lot of pain involved. Sometimes when somebody’s attempting to commit suicide, they’re not 100% ready to die, but they are 100% filled with pain, and they want this pain to end. There may be some version of that attempt that wants that pain to end, but maybe doesn’t want their life to end. So you can see that through the attempts that are not completed.
Okay, so Dr. Hayden, as we’re talking about the idea that some people view this as solution, but some are wanting the pain to end. Let’s differentiate between the two. You’ve mentioned that on several of your power point that often times a person will see this as a solution. However, some people are trying to end the pain. Can you help us to understand between those two, what’s the difference?
Sure. I will put those together, the solution to end the pain.
Solution to end the pain.
Now, not everybody that’s attempting to commit suicide is dealing with the same version of pain.
There’s many aspects of that, but it’s still that idea of a solution. So emotional pain, maybe guilt and shame, maybe just depression. If you’ve experienced a deep depression, it’s hard to explain. It is a dark place that doesn’t make sense. You could have people that love you right next to you, but you feel alone and that there’s no point to life. So that solution is solution to the pain, maybe emotional pain actually chronic pain, and other types of illnesses and terminal illnesses are all on the list for risk factors.
So people dealing with that sometimes they don’t want to continue. So it’s a solution. So solution to various different types of pain as well as to a hopelessness in life, that there is no reason I can’t be the parent I’m supposed to be, or whatever social role, the wife, the husband, I’m not able to meet it, there’s no point for me being here. The solution is to end my life.
Another person could see easily all the good that’s there, and all the people that love them, all the reasons why they’re needed, but the person can’t see that at that moment. It doesn’t always last. Sometimes it does, but sometimes at that moment it makes sense to them, and then give it a little bit of time, and there is that spark of hope and they can see it and pull out of that depression.
Let’s talk for just a moment, and I have a number of questions, and some of them were relating to some of the question I’m about to ask. What do you do in a situation where the person has reached a sense of hopelessness, they’ve never really had suicide ideation thoughts like, “Should I just drive off the freeway or drive into this post?” They’ve never had those thoughts before, but now they have them, and there is potentially a biological imbalance for them. How do you advise in that situation as a therapist?
If somebody is for themselves personally is noticing, their thoughts are scaring them. One thing first I say is, “Remember, thoughts are not behaviors.” So it is something people struggle with and never come near. Attempting suicide is to have the thought. Just because a person has a thought, it doesn’t mean that they’re at risk. For the person having the thoughts, it’s helpful for them to know. They’re not scared and overwhelmed by thoughts. Thoughts come and go.
Just because you have the thought, you can counter that thought, you can work through therapy to decrease those thoughts. Thoughts are not the same as you actually driving off the road. So it’s good to normalize. Also though, if a person’s recognizing it, there’s lots of help. So that’s a great situation. It just doesn’t always happen. If a person recognizes, “Man, these are getting out of hand. I’m having these thoughts. This is scaring me.”
If they go to help, there’s lots of options to pick from. You said biological, so I’m not sure if you’re thinking of medication. There’s medications that can help with depression. Interesting, sometimes that’s the risk. So they’ll put a label warning on antidepressant medication that it could increase the risk for suicide attempts. That’s a frustrating thing, but one factor possibly could be that aspect, they are on antidepressant medication now getting energy, feeling better, but still overwhelmed and ready to end their life. Now, they have the energy.
So there’s that in psychology, a lot of discussion over that. It’s actually the risk factor, but it’s good to know. It’s good to not just presume, “Oh, here’s this great answer.” “Well, make sure you have somebody you trust. Make sure that person’s in therapy with somebody they trust, a psychiatrist, if they’re going to look at medication that they trust and that everybody’s monitoring how the person’s interacting with this medication so you don’t actually increase risk, but absolutely it could be of value.”
I’m a therapist, so it works. It doesn’t mean it works quickly always, but there’s hope, and then you have a partner, then you have a teammate to walkthrough whether it’s yourself or your family member on this road to try to figure out how to pull this person out of where they’re at.
So a couple thing you’re talking about like in a hospital setting, if someone is depressed and they go into a hospital setting, and there’s not a realization that there’s high suicidal ideation, lots of thoughts and then there are plans, and then they gain some energy, and then they leave the hospital and then they commit suicide, this is not too a common. It’s very common, and that’s why a hospital setting will usually very carefully make sure that there’s a therapist on the outside of the hospital to connect the person before they release the person from the hospital. So they’re getting both the care if indeed there are medications, they’re getting both the care of psychotropic medication plus the psychotherapy work.
So you’re changing the thoughts along with the biology increasing and energy and feeling better. So it’s very important. Another point you were making is the different groups of people that are most susceptible. If you showed the groups, we are looking at three to one versus homicides, but you were talking about males and even more aged males because they tend to be more isolated. So part of what you’re talking about is isolatory pieces. That is if you have a friend or a loved one, or a mate, or someone close, parent that is isolated, that raises the risk because of the disconnect, which leaves really a person in more of a hopeless position.
It’s really difficult if you’ve never met someone or worked with someone, or maybe you felt this, but someone that feels hopeless tends to be void of emotion. So their pain is the lack of emotion, if you will. It’s important to look at that when you’re talking with or working with people. This was a question that was asked if we can dive into some of these questions. It says, here, this first one, “My daughter left a message on her friend’s phone saying if she dies, her boyfriend killed her, and her death was deemed a suicide. I’m not sure this is asking necessarily a question. This is very painful, but my daughter left a message on her friend’s phone saying if she dies, her boyfriend killed her and her death was deemed a suicide.”
I’m not sure what kind of question to draw from this, but this is a very painful scenario, because no one will really know apparently in this situation. I guess that there could be forensic and research done on this. One of the difficult things in teaching an abnormal psych class, which you and I both independent of the other have taught many, many times is what’s difficult is it’s difficult to know post-suicide what happened. So it makes it very difficult in gathering data as you’ve seen here this evening, but that’s very painful. Would you like to respond with that situation?
Yeah. One thing I’d like to say is just because it’s common to be careful for yourself personally, and then if you hear things from others, you can add this to them, help them with this is to not hold shame from what doesn’t belong to you, because I think with family members, this would be just a different type level of pain to lose someone and not know why. That’s hard. There’s actually a whole type of therapy that families go through when they lose loved ones to murder or something extreme, because it’s just hard on a person’s brain when they can’t figure out what happened, and why did this happen.
It’s very difficult, but we tend to put shame, or whatever you want to call it, just we put it on our shoulders as family members, and it just doesn’t belong to us. It will harm us now and today in our relationships, and I would just make sure you allow yourself to be free from that, that there’s probably nothing you could have done to prevent it. That’s huge, and that’s hard on families. It’s easier for us to blame ourselves in one little … wherever we could find. So be careful not to blame yourself and be careful not to hold shame when it doesn’t belong to you so that you can have whatever life you have today in a way that’s free from that that bondage that can hold you down with all that.
This question is, “Are suicide notes common?” Do you know the research on that? Are suicide notes common?
That’s a broad question, so I won’t answer it specifically. So yes and no, it depends. Because yes, you will find them, but not always with completed suicides. So suicide notes in general, but not necessarily tied to completed suicides. A lot of times, completed suicides won’t have suicide notes. I will say a lot of times you’ll see the signs after, but there are signs that are hard to see during. So it’s really frustrating, because many family members and therapists can really be hard on themselves going, “Oh, when they said that, now it makes sense.”
So after you look back and you can see these signs, but in the moment sometimes it’s very hard to pick up on them. So that’s difficult. So they’re not as common as you think with completed suicides, but yes they do, you will find them, but I couldn’t tell you statistics on it for sure.
Okay. This next question. My mom killed herself when I was 20- These are very difficult to read by the way. This topic is very, very painful but, “My mom killed herself when I was 28. She had psychological problems, she heard voices. At the time of her suicide, I felt sad, angry, guilty. I grieved and tried to keep my family together. Presently, more than 20 years later, I see her suicide as more of a selfish act and I’m sad for my daughter that didn’t get to know her grandmother. Is it wrong to see her suicide as a selfish act?” You talked about solution, so this question is, is it okay to see this and view this as a selfish act?
I see a couple sides to that. So in one sense, the act of suicide, all the family member, and friends, and everybody else as though are the ones that feel it, are the ones that experience it, have the long-term consequences. If it’s a parent, the kid, even the adult child, the rest of their life, and grandkids, and heritage past down generation to generation. So just the ramifications are huge, and yet in talking with those who have either tried to commit suicide or working with people with severe depression, it’s a trap. It’s a place that the person cannot see out of it. They cannot see.
Is it selfish? You could say that in that one moment, but is the person thinking selfishly? Most likely not, especially with the mental illness. They’re hearing voices thinking those voices are talking to them telling them what to do. They’re seeing things they believe are real. It’s intense, and it’s scary, and the depression could be solo that they’re miserable and they can’t see anything besides that. They can’t see their kid. They can’t see anything.
Now, it’s possible for them to come out of that, but in the moment, they’re not seen life how just an average person would see it. So when they’re committing suicide in that moment, it’s not like they’re thinking and seeing, “I’ve got kids, I’ve got a future grandkids coming. I’m just doing this anyway.” None of that’s probably in their mind, or they wouldn’t be doing it. There’s a whole different experience happening in the body and mind of that person committing suicide.
If a person later, a family member goes through something similar, sometimes they’ll come back around and they go, “It makes sense.” It wasn’t right, I get to live with the consequences, but at least I can understand where they were coming from. How they could get to a place so low and desperate that it was the only option for them at that moment. I see both sides. Is it selfish? It is going to have a negative consequence on everybody that cares about you.
At the same time, those that are going through it, they’re not even seeing that. They’re in a whole different mental place that it’s hard to even grasp if you’ve never gone through that. I would say, it reminds me of the stages of grief. When you go through the stages of grief, you have times where you’re angry, times where you’re depressed, times where you’re denying. So where you’re at now is just probably making it better in life to just see your mom as selfish, and maybe for a time that’s okay, but you might find yourself going through another phase later as well.
Sometimes you just have to ride these waves of what life brings. You might see it differently in the future. You could look at the pros and cons by seeing her as selfish. Does that help you manage today? If you had compassion on that and saw it a different way, is there benefits that could come today to you and your kids that you’re missing? I will think about that. Open yourself up to looking at the different ways of viewing it, that again help you have healthy relationships today.
Thank you. That’s very helpful. This person is an interpreter. This says, “Murder is the ultimate sin. Does God not understand that a person who takes their own life is most likely beyond grief and forgiving grant eternal life.” So I think the question is asking, will God forgive? Will God forgive suicide?
Depending on who I’m talking to, I answer this differently. I’ll give that disclaimer. If you’re talking bible, all through scripture, there’s nothing you’re going to do to gain salvation, and there’s nothing you’re going to do to lose it, that it’s not you. It is God. He became human, lived a perfect life, died on the cross, rose from the dead to have a relationship with you. Even when it talks about the Holy Spirit says, “He’ll seal you until the day of redemption, until you die.”
That aspect in scripture, that’s a theology. That’s my theology. People have different theologies. So you’d have to look at the bible and decide between you and God, what does the bible teach. I don’t see it through scripture that there’s something you could do to break that, because it’s not something you’ve gained. It’s faith and what He’s done. At the same time, if somebody’s suicidal and they’re worried about that, I’m not going to correct their theology in that moment.
I’m not going to correct their theology. I want them to live. So I might change the topic and not say, “You’re safe.” I don’t want that to be one reason they have. So even at online, this is a risky place to even have this discussion if somebody’s really struggling right now. I do think there’s other scriptures that talk though about how much value God puts on life. He gave you that life. It’s up to Him. He values it. It doesn’t matter what you do. It doesn’t matter your production. We have put this value on human life and other ways. That’s not how God does it.
If you’re human, you’re created in this image, you already have tremendous value no matter what. So you see that in scripture and that’s where I might encourage people and bring them back to, not to say, “Salvation secure,” when they’re struggling with this topic. I would be a little hesitant. At the same time, the emphasizing how valuable God believes that person’s life is.
I work a lot in addictions and a lot of times we have suicidal type thoughts along with addiction, especially when they’re getting clean. It’s just miserable, but one thing is most likely how I know God in my bible, He’s got a plan for you. So reminding people, God probably has something in store for you in your future, and having them look forward. They’re not going to feel it at that moment. They’re not going to want to see it, but you say it anyways, and you say, “It’s okay if you don’t see it right now, but I see it.”
It’s in the back of their mind, “I see how God might use all of this to use you for something. He seems to have a plan. I see it. I can’t wait to see what it is.” To help them look in the future of what God’s got in store. Hopefully, that answers the question good enough for now. Of course, a little bit of theology there.
If we just take theology, it’s more of a reformed tradition that you just mentioned, Wesleyan–Arminian tradition would view that a bit differently. So there’d be a balance between Dr. Hayden and myself. So it depends upon where the person is biblically believing. Wesleyan–Arminian tradition would believe that a willful transgression against the known love of God is sin. So that is the idea of taking your own life would be going against God’s desire and you are sharing that a bit that the desire is that He has a wonderful place for you.
I used to show at the university Christian, Nazarene University and I used to show a clip of a man who was planning to take his life and he’d been in chronic pain, and so in chronic pain for 20 years and he couldn’t endure it any longer, and he made plans to kill himself. I showed that then I’d asked the university students to begin to talk about it theologically. That was a very challenging discussion by the way to enter into that. However, I’d be a miss not to suggest that if God has plans for each of us, it’s very difficult as a therapist to watch people that are suicidal.
Yet, if God has a plan for each of us, then for us to make that choice to take our life, the question is, how does God manage that concept of sin? There would be those theologically, it would believe the bible is suggesting that is a sin, because you’re taking your own life, you’re taking your own life that God created. I didn’t create my life. You didn’t create your life. We’re made in His image, and that is beautiful. So it’s a very difficult topic, but just balancing a little bit, that was more of reformed tradition response mine’s more of a Wesleyan–Arminian, and there’s perhaps a balance between the two in some ways, but we probably have to be careful about that concept in working with people rather than giving them an answer is to help them to process.
I wonder what God is saying to you in the midst of this one. I think the point you’re making is that it’s very difficult when someone is suicidal. They are not using their prefrontal cortex. They’re not using abstract thought that’s why Dr. Hayden was saying, when the person is feeling deeply this way, they’re not thinking about their children. I actually had a situation where the person was on her way to kill herself and she called me. I don’t believe she wanted to commit suicide, but she was on her way and she knew the bridge where she was going to crash.
I began to talk to her about her two girls, and talking about that she was going through a very difficult divorce, and begin to talk about her two children. Eventually, she was able to move to a much more abstract thinking, but she couldn’t think that way at first. It was like, “My life is over. I have no purpose. My children will be better off if I’m dead.” That was the language.
I learned something in that process, and that is when there is that presence of another person who cares deeply, that something miraculous can happen when there is connection. I still like in that, to the gift and power of the Holy Spirit that is available even to the worst of life’s situations. I’m looking at all of you here, but if you’ve been through some difficult life situations, I have in my own life, when we seek out the gift and power of the Holy Spirit even though we’re very depressed, or we’re very sad, or we’re despondent even that we do have access to the God of this universe.
I’m a firm believer even in the worst of situations, we have access to Him. I’m certainly not correcting you. I know we have two different views biblically, which is not, there’s nothing wrong with that, or at least I’m suggesting you may not say that two different views, but something to think about with this powerful question, because this next question ties right into this. Maybe we can just respond to it as well. Are there ages or conditions under which suicide is okay? All right, go ahead answer it.
I’m just thinking, he was giving examples of teaching. So, these are the types of topics you throw out to students, and you just go on for hours, and hours and hours looking at all the different aspects, because it’s very complicated. What if somebody has a terminal illness? What if they have extreme pain? There’s various things even those who are possibly on life support. So it’s difficult to know if they’re experiencing life, and where is life. There’s all these complicated issues.
I don’t know if I would even tackle answering that other than to say, “I tend to have a lot of compassion for what people are experiencing and understand where they’re coming from.” I also see how God works and He usually surprises people. So at the moment where it seems like this is the only answer, I have a terminal illness, I have so much pain, I can’t bear it. On the flip side of it, if a person made it through to the other side, there probably would be something there impressive that God does, some way He uses it.
I think appall with His torn in his flesh that God kept saying, “My grace is sufficient for you.” I’ve held that in certain times in my life just very literally I’m holding it and just thinking about that, “My grace is sufficient for you.” So however the difficulties may be, whatever they are, whatever good you have, that grace He’s given is sufficient. It’s okay right now. So that’s going to be hard for people to accept, but it’s the truth. So you have to be careful how you introduce that idea.
It was like at the moment and I, “Well, your grace is sufficient.” You’re not going to do that, but you’re going to at least have it in your mind and be compassionate, and then see if you can’t lead him in a direction to see the teeny tiny light that hope, maybe God’s got a plan after all. Maybe there’s something that he’s going to use all this for. If they can get hope, it’s a game changer, but in that moment, it’s not there. So how are you going to give one piece of hope somewhere that this person can catch? Then it tends to grow. One piece of hope then they could a lot of times find something else to have hope and that could increase.
So well said Dr. Hayden. Isn’t that hope based on connecting?
Being in connection.
You’ve spoken here, and it was a marvelous presentation on addictions. I’m not going on a trail here, but with addictions, people find themselves in addictions who are isolated. Addictions are isolatory. Suicidal ideation feels deeply isolated. “I’m no longer like the woman I just mentioned a moment ago.” She said, “I would be better dead for my children.” So I was asking questions, “Why is that?” Asking her, because she felt deeply disconnected although she had a major depressive disorder at that point, which was severely complicated, which you said up to 90% of suicides.
So, it’s just a very, very, this is a very difficult topic when it comes to isolatory. So when you’re mentioning, “His grace is sufficient,” that’s actually reaching out to the Lord. So that’s reaching out to connection, which when we believe that, our faith is not based in our faith and prayer, it’s our faith is in God. So it’s reaching out to the ultimate source to help us.
Those in the mental health field, we know that often times biology can play huge part. So the person can have great faith, but have totally no hope, no feeling, no sense of hope for tomorrow. This particular question, and thank you for responding to that is this was a really specific question that it was part of a question before where it says, “Are suicide notes common?”
This person asked, “If the victim has plane reservations and is close to finalizing a master’s degree, is that common for suicide?” It’s a real specific question. If the victim has plane reservations, it sounds like someone is facing this, but if victim has plane reservations and is close to finalizing a master’s degree, is that common for suicide?
I’ll more answer it that, you should trust your gut, because nothing and receiving a master’s degree and having a plane ticket is a red flag to me, but something in that person’s situation is giving you that red flag, is giving you that gut feeling. So I would talk with the person. I would wonder where are they flying to? Are they celebrating? Are they going somewhere enjoyable, or is there more to this?
I would say that’s another thing where at the flip side, you’ll look back and you go, “Oh.” So you might as well just trust your gut. Now, you can’t do much about it, and that’s the difficult part. You can say, “Hey, I’m worried about you. Something in about how you’re behaving and how you’re talking, I’m just really worried. I’m worried you’re going to hurt yourself. Have you been struggling with depression? Have you thought of killing yourself?”
They haven’t found broadly that asking a person, “Have you thought about killing yourself” increases the risk for suicide. So they’ll use this in trainings often as specifically, “Have you thought about killing yourself?” You could pick the words, but be very direct. So I would just start talking and just say, “What’s going on? I don’t even know why I’m so worried about you, but I am. So help me understand it. Tell me what’s going on.” Remember, open-ended questions. So not yes, no except for have you thought about killing yourself? That’s a yes, no question.
Do you have a plan? That’s a yes, no question. Otherwise, what’s going on? Talk to me. Why am I so worried? Let them talk with you. Reach out. Something you said to connected with. I was thinking, sometimes people are connected and alone at the same time. When you’re at a place where you might commit suicide, it’s very internal also. These people could be all around you, and you’re very alone.
So the reaching out and connecting is also out of your mind, out of your internal world to your external environment. That’s where friends engage in you and trying to get you to go out, and go to the beach, get in the water, engage your senses, talk, do things that require you to be external and not in your own head can be a tool for pulling a person out of that spot.
Sometimes it’s not just that they are alone physically, but that they’re internal. So consider both. You want a lot of people around them. You want them to connect with people, but you also want them to connect, not just be present. You have to have a way for them to engage. So whoever this person is, start talking to them. Engage them. Get that conversation going.
Okay, so a lot was said there, and I think it’s very important. So if we internalize things, that’s like someone who ruminates and they can’t quite go to sleep. You’re ruminating, you’re thinking about something and it’s cycling like the hamster in the wheel, and it’s going nowhere fast, and it’s just cycling. So that’s I believe what Hayden you’re talking about is when it’s internalize, a very good thing is to actually have your somatic that your body engage. That’s why you were saying if you can go swimming, or at the beach or something that often times we’ve lost the ability to feel in our body, because we’re all in our brain. We’re just internal is what …
So something that can be helpful, it’s one of the four ways to decrease anxiety, which sometimes we see that in suicidal ideation or suicide is that you could do what’s called, “Progressive muscle relaxation.” That’s where you would tighten up tendon muscles like your face. You tighten up and then tighten up for maybe six seconds and release for four. Then go down your entire body down to your toes. That can take about 15 minutes. That can relax your body, give you lots more oxygen, and then give you insight into what your body’s saying.
You said earlier that trust your intuition. Women are much better at this than we as men are, because we can compartmentalize and our brain works differently. That is to be aware of what’s happening physiologically. If you’ll notice the language, the language of open-ended or closed-ended questions that Dr. Hayden used. So a closed-ended question, which is very direct can be very helpful and that is, “Are you planning to hurt yourself? Have you thought about hurting yourself? Are you planning to kill yourself? Do you have plans to do so?”
Notice my voice goes down when I say that? It ends with, “Are you going to do that?” Open-ended question usually raises your voice. “Would you be willing to talk about this?” If you’ll notice, my voice is going up, that engages more conversation. So open-ended questions engage more conversation, which is why you were mentioning that a lot of people need that kind of connection, because they can feel isolated even though they’re in a large group of people.
So even the way you use your voice can be important. When someone’s being authoritarian, or excuse me, authoritative, authoritarian, excuse me, they would actually press their voice down. You’re going to do this. When you’re trying to engage, “Would you consider doing this?” Your voice overemphasizing this. It goes up, which brings more connection.
This next question is, “How do you deal with teenagers that use this as a way kind of a leverage?” How do you address a teen that uses suicide as leverage such as, “If I don’t get my way, I’m going to kill myself,” the teen says. This is a very common experience, I’m sure you in your practice. I hear it all the time. This is a very good question. When somebody is using it and you believe, intuitively, you believe they’re using to leverage.
When I was first teaching, my wife and I were teaching our children how to actually develop their emotional acuity and that is to be able to know what they’re feeling is I remember they were learning that early on. I remember my son turning to me, and he was using leveraging. We were teaching him how to know what he feels. So name what you feel. He said, “I just feel really uncomfortable with what you just asked dad.” I was asking him to clean up his room.
I said, “You may be feeling uncomfortable. You’re going to clean up your room anyway.” The idea that sometimes children will use something. Have you ever had something like that happen to you with leverage? What do we do with a teenager? Back to more of a serious note who may be using this, “I’m going to kill myself,” the teen says.
Sure. You have a balance here. One, you do want to be careful to take things serious, because even those who are using it for attention sometimes are at high risk still. They’re communicating a message even if they’re trying to manipulate if you have that concern. “Are they just doing this to get my attention so that I back away and I don’t follow through on discipline or so that they can get something that they want.”
So you want to be careful that that behavior isn’t tied to that. For example, if they said that and they didn’t want to be grounded anymore, then you would still have them grounded, but you could still address it. “I’m really concerned, so talk to me about what’s going on.” So you could take it serious, but not let it stop anything that’s in place that they might be using it for leverage.
So if they’re trying to get something, you don’t want to overreact and act shocked, and then give them what they want fast. The first thing I think of is basically not to have a reaction. So that is probably a little bit of a personal style more than this is a good idea. I think you have to know your teen. I tend to have game face first. It’s like, so you want to act concerned, and validate and give them opportunity to discuss, but not shock, not reaction.
Be careful it’s not tied to getting out of consequences or getting something they want, just in case. Make sure that’s there. Then something’s going on, they’re communicating whatever that is. Now you have to figure out what the message is. So having open discussion. Talk to them about what’s going on. This is really serious. People struggle with this. Tell me more about it. Again, open-ended question.
If you ask questions in such a way where you give them words to say, then you want to avoid that. You want to know what’s in their head. Before, you say much more that they basically turn around and use back to you. So you want to say, “Tell me what’s going on. Tell me more about this,” and just get them to talk. Maybe something is going on. Maybe they’re just using that because they heard it, they’ve seen it. There’s a lot more exposure to this topic everywhere, so you’re going to have it use more.
Maybe they’re not really thinking of committing suicide, but they’re communicating, something bad is happening that I don’t feel like I can handle. So I need a way out. So they’re communicating. That’s fantastic. They’re communicating to you. So get them to talk about what’s going on? What’s going on at school? What’s going on with relationships? Get them to open up and figure out what’s going on.
So you’re also trying to figure out how to give attention for valuable communication and less attention if you think that it’s along the idea of manipulating. The hard part is you might not be able to guess correctly. So you want to be careful. You want to be watching. You want to watch other behaviors. Do you know their friends? Go back to all the risk factors. Do they have six of those risk factors? Then be careful.
You want to intervene if they need it. Would you be open to seeing a therapist? Go as if this is real, this is true. Get them to open up, see if they want to get support. If they’re just using it as a manipulation, they probably won’t want therapy and it’ll probably won’t last long. You want to be careful that there’s not something really going on, and you presume, and then you’re wrong. You want to have both sides dealt with. You want to be careful that they’re not getting away with something, and sure, pay attention to that, but also get that communication open. Make sure there’s not more going on that you didn’t realize and that they are at risk.
So separating manipulation from what they’re truly feeling. So an open-ended question would draw out more feeling. Another way to approach that even is to use a refrain. So I’m hearing you say that because you have to stay home tonight and not be with your friends, you want to kill yourself, and you’re being serious with I’m not joking with them. Is that what I’m hearing you say? You’ve actually voiced back what they’ve said, and you could even ask if they were open to it, and willing and been trained in a way earlier in their life is to say, “What’s behind wanting to kill yourself? What are the feelings behind it? Are you feeling afraid? You’re feeling scared, you’re feeling unhappy, you’re feeling cornered, whatever what’s behind it.”
So that now they’re beginning to, as you would suggest it’s so great, to open up even more. Here’s another question. We have just about 10 minutes left, so we have time for this question. We’re doing very well on our time I think with our questions. I wanted to mention, the person that I said that was planning to kill herself, fortunately, she did not that night. I couldn’t sleep the rest of the night after I had that experience on the phone, but she was safely, safely gave herself up, we had a 5150, we were able to have help of PERT team come out and help, which this next question relates to that.
I was so struck by the issue that that evening I’m her therapist and I never had anyone commit suicide, and I’m thankful to the Lord I’ve never had anyone since. I’ve never had one in any of my practice. I hope that I will never have one of my patients. You can’t guarantee that. It could happen tomorrow on my practice, but I’m thankful it hasn’t. In that case, I noticed that the connection that I had, the alliance we call it was really important at that moment, that if she could trust the fact that she may well have something to live for, and that’s connection.
This question does tie into the PERT issue. We had PERT help us. Pert means Psychiatric Emergency Response Team. So typically, am I correct? Typically in a PERT team, we had a presentation about seven, eight years ago in her about a PERT team, someone on the team. Usually, you have someone like Dr. Hayden or myself, a licensed mental health provider with two police or two sheriff officers. That’s usually a threesome, typically. Am I correct? That’s pretty typical.
So we had a PERT, P-E-R-T, it’s this Psychiatric Emergency Response Team help us with a person who’s displaying all these symptoms. He is very angry with the person who called 911, does she, the person who called, have to worry about him retaliating against her. This is a very good question. In our litigious society, say you have someone who go, “If I call 911, this person’s going to be,” and then they’re risk off to the, they’re taken off to the hospital, “Am I going to be responsible for this? Am I going to be sued?” This is a tough question.
Sure. One thing I’m thinking is it sounds like this person was taken.
It sounds that way. Yes.
So if that’s the case, there’s a lot there that the PERT team saw that person needed to go. So when you’re calling, which is something good to know that you can do this, in San Diego, there’s not always that team available, but they do the best they can because otherwise it’s police officers coming. If they think the person’s going to harm themselves, they’ll take him in, but they’re not the same type of person to assess. They’re honestly sometimes, it’s an overwhelming thing.
The PERT team will do a good job assessing. If that person’s really in danger, they’ll take that person to a hospital. It’s good for you to know you have that resource. You’re not going to be able to judge, but if you think that person’s really at risk, it’s okay to call. They’ll do that job. They’ll do that assessment to decide. You could do a health and welfare check. They just drive by, they knock on the door, “Hey, how you doing? Somebody called, said that they’re worried about you. Can I talk to you for a while?” They’ll start assessing and figuring out the risk level.
So you’re just getting them connected with the person that’s going to do a good job assessing. That’s usually never seen as a negative. It doesn’t mean that person won’t be really mad at you. Anybody can sue anybody for anything, so you could get sued. I don’t know if that would hold up. They’d have to have a whole lot on their side like showing harm that you did and various things. So you probably will be okay, but the person might be angry.
As counselors, we deal with this a lot, because we might call and then the client’s never coming back because they’re really mad. It’s got to be okay. You’ve got to put a person’s life as the highest priority, and it doesn’t mean you’re going to be able to guess correctly. Maybe they weren’t really at risk. You’re usually going to take a chance on the side of being safe, because you’re protecting, if you can, a person’s life that’s usually going to have to be a priority.
There might be a time you’ll lose a friend, but a lot of times what’ll happen is they’ll be really angry at the moment, and then later come back and thank you. They’ll get help sometimes. They’ll be in a better place. They’ll understand and they’ll come back, and they’ll appreciate what you did. Even if the person’s angry right now, it might not last. If it does, that’s okay. You could only make the decision with what you’re looking at.
If you’re concerned, something’s standing out that this person’s at risk and their life is important to you and any life should be. If PERT comes and takes him, you know something’s standing out that this person’s at risk for harming themselves. We have to jump in and try the best we can to prevent that whether they like it or not.
Yeah. Just a little addition to that, in the state of California, as many states that licensed mental health provider, or an associate, or a psych assistant depending upon the license, that if we are with someone and it rises to a level of suspicion, notice the language, if it rises to the level of suspicion that the person is going to self-harm, or of course they’re planning to harm someone else, that’s to tear us off, that’s a completely different topic, but still nonetheless, if it rises to a level suspicion and we call for help, we’re never liable under any litigation.
So we’re protected by law because we are the first one to assess. We’re not really assessing, but if it rises to a level of suspicion, so there is a level of assessing, that we are obligated to call, which means that really helps the rest of us know, if it rises to a level intuitively as you’ve mentioned, we talk a lot about that as therapist. Your intuition as a therapist is really important, that you intuit something, that’s the incredible piece of being human, that we have a high intuition that is not true of animals, but as humans we do.
So that rise into a level of suspicion that it’s better to actually here on the side of conservatism because of the person we don’t know if they will or will not, but we take the step. This person here [inaudible 01:09:29] same discussion, when a parent is going through the same struggles, and by the way, I’ve gone through all of the questions. I’m not always able to accomplish that, but we have tonight, and we have about four minutes left. When a parent is going through the same struggles as the child like anxiety, depression, suicide, how do you talk to him or her when you are struggling with it yourself? What a good question. It’s painful though if you are experiencing it, someone is apparently.
Also could be a great value to have that authenticity and to have that openness. I can’t quite tell if it’s the parent writing and they know their kids going through it, maybe adult kid, but they’ve experienced it, they understand it, and in here, they have this generation pattern. If it is a parent, one thing I always tell parents, because sometimes they struggle with shame and guilt, and their difficulties, they can see how it’s impacting their kids and that’s hard, I remind them first of all, the negatives of shame. It usually doesn’t produce much good, but also whatever help they get today, however they improve today matters. It has a ripple effect.
Now their kids sees it even if they’re adults. They see anything you do on a positive direction now and that matters. I don’t care if they’re 30 years old. They watch it, it makes an impact. So it’s never too late to try to get help, to improve your life, to fight it, not just dive into it, but to do whatever you can to pull out of that and get into a good healthy place. As you do that, your kid’s watching you. They may not go there yet, but it’s another version of modeling.
They might have seen and they went in that direction, because they were experiencing similar things, but now they see health and they’ll also be excited to go in that direction at some point. There’s more hope than you realize. Otherwise, just to be I would say, transparent, open, you still want to be careful to come to conclusions of I believe life is so valuable and that God, even if you’re struggling to believe this, that God probably has a plan and purpose for me and for you.
We’re going to make it out. We’re going to do this. Let’s work together. Let’s go find help together. Team up, collaborate, connect. We’re coming back to connection.
We are in connection. Would you join me in thanking Dr. Julie Hayden who’s our presenter this evening dealing with suicide. We’re so glad that you came this evening. I hope that this was helpful to you. It will be video recorded of course, and it’ll be available to you. Our next presentation in a month will be infant loss grief due to miscarriage, stillbirth, labor complications. Dr. Nikki Watkins who’s a specialist in this particular area, and she speaks on this area, teaches on this area, and is a therapist who works specifically here.
Thank you for attending to our evening here at My Therapist Sez. We’d like to close with a word of prayer. Again, thank you for taking time out of your evening for those that are listening live streaming and those later who will be listening to this via video.
Father, we thank you for this evening. Thank you that you’ve given life, and thank you for the privilege we have of life. We just pray your blessing up on all that we’ve discussed here this evening. We count on you, the one who really takes this concept and helps us to deal with it in a way that will be pleasing to you. We give you praise. We honor you this evening. In Jesus name I pray, amen.
Once again, thank you for attending My Therapist Sez.
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