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But these studies are, by their very nature, of dubious evidentiary value.

There’s no control group of “distressed/suicidal people who called hotlines” to compare to, and the pool of callers is an inherently self-selecting population, which may or may not reflect the population of people who are at greatest risk.

Given the social and religious stigma that continues to be associated with thoughts of suicide, we might posit that the higher-risk a caller is, the anxious they are likely to be.

They may perhaps be reluctant to agree to a follow-up call when asked, and nervous to call the hotline again if they suspect they might be part of some study.

One thing you learn quickly, from taking these kinds of calls, is that misery has no respect for wealth or class. Misery is everywhere: it hides in gaps and secret spaces, but it also walks abroad in daylight, unnoticed.

They are people who are deeply miserable and afraid, who are repelled by the idea of ending their own life, but who still say that they wish they were dead, that they wish they could cease to exist by some other means.

Among the most common topics of discussion are heartbreak, chronic illness, unemployment, addiction, and childhood sexual abuse.

I think they imagine that I regularly talk callers off ledges, like a Hollywood-film hostage negotiator. In reality, the vast majority of your time at a hotline is spent simply listening to strangers talk about their day, making little noises of affirmation, and asking open-ended questions.

The conversations you end up having on a suicide hotline are inherently somewhat peculiar.

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