Author: Huang Yuqin
The sound in the bungalow
This is a row of bungalows that look inconspicuous.
The white exterior wall has turned yellow, and the bushes in front of the door are jagged due to lack of trimming.
When I first came here, it was hard to imagine that in such a building, rescues of life and death were carried out almost every day.
Beijing psychological assistance hotline.
Photo by Huang Yuqin
The "Beijing Psychological Assistance Hotline" on the signboard outside the house and the ringing of the telephone in the house one after another distinguish it from ordinary bungalows.
In the depths of Beijing Huilongguan Hospital, the first national crisis intervention hotline is located here.
September 10 is Teacher’s Day, and many people don’t know it is another special day—World Suicide Prevention Day.
Suicide, as the most secret wound in human society, has become a global public health problem.
According to the latest estimate of a report released by the World Health Organization in June this year, more than 700,000 people died by suicide in 2019, that is, 1 in every 100 deaths was suicide. Suicide is still one of the main causes of death in the world.
In 2002, Canadian doctor Fei Lipeng established a psychological crisis research and intervention center in Beijing Huilongguan Hospital, and set up a nationwide Beijing psychological assistance hotline.
At that time, Fei Lipeng and his Chinese colleagues published a study in the authoritative medical journal "The Lancet", which showed that 23.2 people per 100,000 people commit suicide in China every year, and a considerable number of suicides have not received any help.
Entering from the front door of the bungalow, the wiring room is on the left side of the corridor, and the fluorescent lamp is clearly projected on the milky white floor tiles.
The 30-square-meter room is divided into 10 compartments. In each compartment, a computer, a palm-sized black phone, a monaural microphone, and a large water cup constitute each hotline operator participating in the rescue "All the equipment.
The phone rang, the operator pressed the answer button, and the first sentence uttered was not "Hello", instead, "Hello, psychological assistance hotline".
After the telephone ringing stopped, the only sound in the room was the answering sound of 10 operators.
Faced with help-seekers from all over the country, they talked with each other about depression, suicide, death and other topics on the phone, but their tone was calm as if they were talking about tomorrow's weather.
On the other side of the phone, the most complex emotions in the human emotional world are brought together.
Grievance, anger, despair... Every emotion is transformed into cursing, sobbing, sobbing, crying, and even a simple sentence "I want to die."
All this is transmitted to this 30-square-meter room through a telephone line, waiting for comfort, guidance, and even a rescue of life and death.
High-risk calls
Wang Jingna, who has been working on the psychological assistance hotline for 13 years, can deal with almost any problem of the caller freely.
But she recalled to me the first time she received a high-risk call, but she was far from calm.
"Actually, I called just to ask if I would die if I jumped down from the 20th floor?" A woman who was asking about depression treatment suddenly said on the phone.
She told Wang Jingna that she was standing on the balcony of the apartment.
After just two months of work, I received a high-risk hotline for the first time. She was afraid and worried that Wang Jingna didn't know how to answer.
"Well, you tell me three things." The female voice on the phone was cold.
Wang Jingna panicked, subconsciously feeling that these three sentences determine the life and death of the other party.
She can only do her best to keep her tone steady, "In fact, depression is really treatable."
"This is the first sentence."
"Am I only able to say three sentences?" Wang Jingna's mind was blank, and she almost blurted out.
"This is the second sentence."
Wang Jingna's hands were already shaking, and she couldn't think of what to say in the third sentence.
"That's it." The other party hung up the phone.
The first high-risk connection was interrupted in such a dramatic way.
The so-called "high-risk calls" are the hotline center's assessment of the caller's suicide risk.
Suicidal behaviors in the past two weeks, suicidal behaviors just or in the process of committing suicides, planning to commit suicide behaviors in the next week are all high-risk categories.
The sudden interruption of high-risk calls does not mean the end of the intervention.
Although she had "cold hands and feet and was trembling all over," Wang Jingna called back immediately as requested.
The "beep" sounded for a long time, and each sound seemed extremely long.
Almost when the call was about to hang up automatically, the familiar female voice finally rang in the headset.
Wang Jingna seized the hard-won opportunity, and through detailed understanding and persuasion, the other party finally agreed to go back to the house to sleep before hanging up the phone again.
It was early in the morning, and the first high-risk call to intervene was temporarily over.
According to the requirements of the hotline center, all high-risk hotlines must be followed up after the end of the call.
The first time within 24 hours, the second time a week later, the third time a month later, and six follow-up visits in one year to understand the caller’s condition.
"She took the initiative to receive treatment later, and her condition improved a lot," Wang Jingna said.
Understand in listening
In the hotline center, a standard psychological intervention can be roughly divided into three stages.
After saying "Hello, psychological assistance hotline", the operator started the stage of emotional relief and problem clarification.
Start by listening to understand the problems encountered by the caller, the emotional state they are in, and the help they hope to get, and establish mutual trust and connection.
Then comes the stage of depression and suicide risk assessment. The operator will judge the depression degree of the caller based on the caller’s expression.
If you encounter a high-risk call, you will usually directly ask the other party "from 0 to 100%, how much do you want to commit suicide".
However, the answers often get are 200%, 500%, 1000%.
Problem solving and summary is the final stage. The operator and the caller will talk about the specific problem, and according to the caller's request, try to find the answer in the question together.
From the tension of the initial connection to the proficient handling of problems at different stages, it takes time to accumulate.
Wei Xiaoyan, who joined the line at the beginning of the establishment of the psychological hotline, internalized her more than ten years of experience in every answer, and formed her own methodology: listen more, talk less about the truth, ask more positively, and use less rhetorical questions. Sentences, lower the intonation steadily, and avoid using words like "should" and "should".
When comforting others in her life, Wei Xiaoyan was also used to saying, "If you want to open a little bit, everything will pass."
But the work of the psychological hotline has changed her way of speaking, "If you say that you want to open up a little bit, can the other party want to open up? If you say it will pass, does the other party really think it can pass? Often it is not."
By listening, recognizing the pain and helplessness of the other person is usually the first step in opening a conversation.
The ability to empathize is particularly important in all intervention techniques.
"High-risk callers will feel painful and unhappy, or they will lose their minds. The first time I listened to how they expressed their pain, rather than telling them what to do." Wei Xiaoyan said, "In fact, what they need may not be to stop the pain immediately. If we want the other party to accept the painful stage, we must first understand it. The emotional reactions that accompany pain are normal."
However, understanding the reason why the caller wants to commit suicide is by no means the same as approving the other party's suicidal behavior.
Empathy is only the beginning of dialogue, not the ultimate goal.
According to Wang Cuiling, director of the psychological assistance hotline, "empathy must be able to enter, but also to be able to come out."
The principle of the psychological hotline is that no matter what happens, the safety of life always comes first.
Never support the way to solve the problem by hurting yourself, this is the attitude that every operator needs to express clearly.
"Empathy is to build an alliance with the caller, but empathy is not enough. It is necessary to return to the role of intervention and discuss the way to solve the problem with the caller." Wang Cuiling told me.
Hotline wiring room.
Photo by Huang Yuqin
Get rid of one's own predicament
A telephone line connects the helper to the operator.
When you can't see the other person, sound is everything.
In the operator's memory, behind the different sounds of high-risk calls, there are unique signs of danger.
In the earpiece, if there is noise from a strong wind, the caller may be standing by the window of a tall building.
If the other party’s answer is intermittent, with strenuous coughing from time to time, the caller may be strangling his neck with the power cord.
If you suddenly hear the crisp cracking sound of a glass bottle falling to the ground, the caller may be drunk or have just taken dangerous drugs.
Sensitivity to sound also affects the operator's own life.
In the past, as long as the phone at home rang, Wang Jingna would always squat in her heart. In her dreams, she would dream of endless follow-up notebooks and endless phone calls.
Nowadays, her mobile phone has been muted for almost all the years, and she does not want to answer any unfamiliar calls.
In recent years, she has also become reluctant to speak actively, and silence often takes up most of her time when she returns home.
Long-term intertwined with negative emotions, the "emotional trash can" is what many operators call themselves when they are joking.
How to solve and protect oneself in time is a realistic problem faced by every operator when he is repeatedly involved in a period of sad emotions.
Forgetting may be a way.
During the interview, it is often difficult for the operator to remember the complete case of the caller.
The mood at that time, the details of the story, and the state of the answer, all left only fragments in the memory.
"Forgetting may be self-protection in the subconscious." Wei Xiaoyan said, "In the first few years of get off work, I would still find my family and friends to sigh after work, but now I basically forget it after get off work."
In addition to subconscious forgetting, institutionalized training and supervision are also needed.
Guo Yiwei, who joined the hotline in 2019, basically belongs to the youngest group of operators. She always remembers that during the wiring training, the experienced supervisor warned, "Whether it is the topic discussed with the caller or the emotions that you have generated, you must stay In this row of bungalows, it is enough to take yourself away when you leave."
The hotline center generally conducts collective supervision once every two weeks, and each operator participates at least once a month.
At the supervision meeting, the operator will take out the call recording that he is confused to share with everyone.
The process of group discussion is not only business discussion, but also emotional relief.
In addition, the ethical dilemma also accompanies the operator.
"I was born not to decide by myself. Don't I even have the right to decide to die?" This is a question that callers often raise on the verge of emotional breakdown, and once made many people doubt the legitimacy of crisis intervention.
However, front-line operators always believe that psychological crisis intervention and the right to life self-determination should not be confused. The caller made a suicide decision in an ill and irrational state. At this time, saving lives is the greatest ethics.
Success and failure
Words such as "intervention success" or "intervention failure" are often easy to cause resistance from operators.
Although Wang Cuiling told me that the general follow-up rate of high-risk hotlines can reach about 78%, the lack of contact does not mean that the caller has committed suicide.
And, including her, almost all operators generally believe that “the caller’s failure to commit suicide does not mean that we succeeded, nor does it mean that we failed.”
After engaging in the career of psychological crisis intervention, Guo Yiwei felt that the biggest misunderstanding he encountered was being "sublime".
The outside world always thinks that they have the ability to intervene to "put alive" those who attempt suicide.
But in fact, there has never been a problem, and it can be changed in a few words.
This awareness of one's own limitations often comes from a sense of powerlessness in the actual intervention process.
"What we can do is actually very limited. We just accompany the caller to the side when they ask for help." Guo Yiwei said, "No one can help the caller bear the pain. They are the ones who need to face their own lives. "
The moment when each operator feels weak is different.
Sometimes when the caller is prepared to commit suicide because of debts, he borrows money from himself after being discouraged, but there is nothing he can do.
Sometimes it happened before the end of the call, after a long time after persuading the other party with all my heart, the other side of the phone said casually, "I just cut my wrist again."
The stronger feeling of powerlessness occurred at the beginning of the call when the other party spoke out in a particularly calm tone, "I am not calling for help, I just hope that I can have a chat with someone before I die."
But in a sense, the limitations of professional interveners mean the possibility of others.
"I don't think I have much patience, just play a role of companionship." Wei Xiaoyan said, "but if the people around the caller can be patient and give them more time, try to understand their distress, try Listening from their perspective, there may not be so many people who want to commit suicide."
In Wei Xiaoyan's impression, a shout is always particularly clear.
A caller told her that when she was diagnosed with depression, everyone around her told her not to worry, she would get better later.
But after two years, family and friends began to be disappointed, and they would complain that they didn't work hard enough, "Why is it not good for so long? I still want to die and still can't work."
"The caller said to me that he really has no way to control his emotions, not that he doesn't want to be good, he wants to get up faster than anyone else." Wei Xiaoyan said, "I think when he said this, That kind of voice is simply a shout."
Wang Jingna even encountered the deception of the caller.
The other party called in the middle of the night, saying that he had just taken the poison and was walking on the street alone, not knowing where he was.
According to the call record, Wang Jingna retrieved the contact information of the family member reserved by the other party from the database.
But the family said she was in the next room and didn't go out at all.
The scam was found out, and the caller was furious and immediately hung up the phone.
After seeing a lot of similar things, Wang Jingna also had an understanding in her heart.
"This kind of deception is different from ordinary deception, because she knows that she will commit suicide immediately. We will worry more and pay more attention to it, hoping that we can spend more time with her. But this kind of emotional feedback may not be able to get from her family. ."
Calls waiting in line
Every caller has waited a long time before being connected.
"I really didn't expect that I would have to line up even to die." "Whoever wants to commit suicide to call you would never want to die. They want to die after waiting." This is the complaint of callers that Wei Xiaoyan and others hear most often.
Even when I answered the phone, snoring was heard in the receiver.
The other party waited too long and fell asleep.
The 32 front-line operators were divided into day shift and night shift, from 8 am to 4 pm, and then from 4 pm to 8 am the next day, 24 hours a day.
Even so, only about 120 calls can be answered a day, which is far from enough compared to the more than 2,000 incoming calls per day.
Every operator can see the number of calls waiting. Wei Xiaoyan described herself as sitting at the registration window of a hospital. The line in front of her will never end.
Although the suicide rate in China has dropped significantly in recent years and is already at a low level worldwide, there is still a gap between the rising demand for crisis intervention and the limited number of practitioners.
Wang Cuiling told me that there are currently more than 60 suicide intervention hotlines across the country, but due to the different levels of investment and attention in various regions, the scale of the hotlines is also uneven, and training and retaining people is the biggest challenge.
It may be unrealistic for psychological crisis intervention to rely entirely on professional assistance. The psychological assistance hotline is only a basic link in the suicide intervention chain.
Fei Lipeng, the founder of the hotline, pointed out in a speech that suicide prevention is a complex issue, and psychiatrists and psychologists should not be the only ones doing it. Individual, social and government forces must be used to establish a complete national level of suicide. Prevention system.
Today, more and more forces are participating.
Wang Jingna recalled that for a long time, the first sentence of the caller was, "I searched for suicide and sleeping pills on the Internet, and found your phone." Maybe the other party did not intend to commit suicide, but the behavior itself was enough. good.
September 10 this year is the 19th World Suicide Prevention Day. The theme of this year is "Show Action, Create Hope".
But for Wang Jingna and others, "every day is a suicide prevention day."
There is not much difference between this day and normal times, and the time is still occupied by constant calls.
They still have the problem of not being able to make calls.
"At this time, as long as they don't give up, don't give up to call, don't give up to ask for help, we will try our best to help them," Wang Jingna said, "but they must not give up."
Don't give up.