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Predicting suicide attempts in patients – word association tests seem to provide more accurate prognostic guides

August 30, 2010

Word association tests were a key part of the early history of depth psychology and were used extensively at the Burgholzli (University of Zurich psychiatric hospital) under the directorship of Eugen Bleuler by, among others, Carl Jung in linking Freuds theories to empirical study of psychotic phenomena. The basic format of the test was to present the test was to ask test subjects for their verbal associations to a list of words. The response to each word, the delay in making the response and any non-verbal response were all noted.

"Our conscious intentions and actions are often frustrated by unconscious processes whose very existence is a continual surprise to us. We make slips of the tongue and slips in writing and unconsciously do things that betray our most closely guarded secrets-which are sometimes unknown even to ourselves. . . . These phenomena can . . . be demonstrated experimentally by the association tests, which are very useful for finding out things that people cannot or will not speak about.[The Structure of the Psyche,"CW8, par. 296.]

Writing about these tests, whose subjects included Sabine Spielrein, led Jung to develop his theory of complexes. Complexes are sets of unconscious associations, assumptions and responses that are characterised by a common "feeling tone" which, without the awareness of the individual, influence the individual’s conscious attitude.

[A complex] is the image of a certain psychic situation which is strongly accentuated emotionally and is, moreover, incompatible with the habitual attitude of consciousness.["A Review of the Complex Theory,"CW8, par. 201.]

The via regia to the unconscious . . . is not the dream, as [Freud] thought, but the complex, which is the architect of dreams and of symptoms. Nor is this via so very "royal," either, since the way pointed out by the complex is more like a rough and uncommonly devious footpath.[Ibid, par. 210.]

Research psychologists at Harvard have published reports on two word association tests used as prognostic indicators of suicide attempts. In an article on

"Experts have long sought a clear behavioral marker of suicide risk," says Harvard Professor of Psychology Matthew K. Nock, an author of two papers describing the new assessments of suicidal behavior. "The current approach, based on self-reporting, leads to predictions that are scarcely better than chance, since suicidal patients are often motivated to conceal or misrepresent their mental state. We sought to develop more sophisticated, objective measures of how psychiatric patients are thinking about suicide. Our work provides two important new tools clinicians can use in deciding how to treat potentially suicidal patients."

Nock and colleagues report on the tests in two papers, one in the current Journal of Abnormal Psychology and a second published in Psychological Science. Unlike many previous efforts focused on biological markers of suicidal behavior, their work identifies two behavioral markers: subjects’ attention to suicide-related stimuli, and the extent to which they associate death or suicide with themselves.

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