MIACE 2020: New Approaches to Working With People Who Are Suicidal


In spite of the growth of national and local suicide prevention efforts, there has been a steady increase in suicides in the United States since 2000. This is true for our veterans too.

This leads to an obvious conclusion: We need to rethink our efforts to help people who are suicidal.

In March, Mad in America Continuing Education will launch an 11-seminar course titled: Innovative Approaches to Working With People Who Are Suicidal. The eleven presentations will focus on the following:

  • What are the social factors, such as unemployment and gun ownership, that are known to affect suicide rates? Do antidepressants reduce—or increase—the risk of suicide?
  • Research that provides insight into how to address the increased risk of suicide associated with the presence of a gun in the home.
  • How doctors can assess whether drug treatment may be provoking suicidal thoughts and behaviors.
  • A public health effort in Oregon that, by carefully analyzing risk factors for suicide, has reduced suicide rates by 40%.
  • Innovative programs, including several developed by people with lived experience, that are proving to be effective in lowering the risk of suicide.
  • How to protect mental health providers from liability when working with people who are suicidal.
  • The efforts of an indigenous, youth-led organization in Canada, We Matter, that is working to reduce suicide among Native American youth.

The presenters are nationally known for their research and programmatic efforts to develop more effective ways to help people who are suicidal. The course will both provide new insights into understanding the factors driving the increase in suicide, and tell of “therapeutic” approaches that “demedicalize” suicide and instead offer new ways to help people in crisis.

We have developed this course with the thought that it will be of interest to professionals and lay people alike. We have titled this course “working with” people who are suicidal to emphasize that innovative approaches do not focus on “treating” the suicidal person, but rather on developing collaborative relationships. Four of the eleven webinars will tell of successful peer approaches to grappling with suicide.

We are reaching out to national professional associations, as well as state and local mental health programs, as we want to present this course to those outside our usual MIA readership. If you belong to such an organization, or want to promote this course to one, please share this blog; or the link to the Continuing Education page. We have also prepared a one-page course description that you can send to others.

We will apply for 1 continuing education credit for each webinar. The fee for the 11-seminar course is $150; however, the early bird rate, which will be available until February 15, is $75. We will also provide reduced “group rates” for organizations. Anyone interested in group rates should contact me at: [email protected].

We hope you will help us make this course known to a larger audience. Here is the lineup and schedule:

Thursday, March 5, 1:30-3 PM Eastern, 10:30-Noon Pacific
Robert Whitaker, Author and Founder, Mad in America
Title: Suicide in the Age of Prozac: A Review of the “Evidence”

Description: This presentation will provide a review of suicide rates for the last sixty years, and investigate the factors that may be driving the steady increase in suicide rates since 2000. It will explore the societal factors—such as unemployment and gun ownership—that are known to influence such rates. Next it will examine the rise of suicide prevention programs since Prozac arrived on the market in 1988, and the commercial and guild interests behind those efforts, which have emphasized the prescribing of antidepressants—and access to psychiatric care—as helpful to reducing the risk of suicide. Does this medical-model approach work? The presentation will review the research on the effectiveness of such efforts, and the research on the suicide risk associated with use of antidepressants.

Thursday, April 2, 1:30-3 PM Eastern, 10:30-Noon Pacific
Paula Joan Caplan, PhD, Du Bois Institute, Hutchins Center for African and African American Research, Harvard University
Title: Issues in Dealing with Suicidal People… and What Experience with Military Veterans Teaches about Nonpathologizing Approaches for All

Description: Massive experience calls into serious question the traditional mental health system’s approach to suicide, while other approaches have been helpful. The speaker will challenge the automatic labeling of people as “mentally ill” because they report having suicidal thoughts or have attempted or committed suicide. She will discuss an alarming way the DSM-IV and DSM-5 encourage the pathologizing of suicidal thoughts. Then she will describe primary reasons people have thoughts of suicide and what can be understood once one takes a more humane, nonpathologizing approach, using examples from a stage play, an Oscar-winning documentary about a “suicide hotline,” research and clinical work about the effects of various kinds of trauma, and a project primarily involving simple, wholehearted, nonjudgmental listening. Using examples from her work with military Veterans and with nonveterans, she will discuss the wide range of other approaches that are helpful to people who feel suicidal.

Thursday, April 16, 1:30-3 PM  Eastern, 10:30-Noon Pacific
Matthew Miller, MD, MPH, ScD Professor of Health Sciences and Epidemiology, Northeastern University
Title: Guns and Suicide: Preventing Deaths by Suicide without Necessarily Affecting Underlying Suicidal Ideation or Behavior

Description: Dr. Miller will present an overview of the epidemiological evidence linking the availability of household firearms to suicide mortality, discuss the rationale for why reducing access to firearms can save more lives than perhaps any other suicide prevention strategy, and delve into some of his suicide-related work among military veterans, adolescents seen in emergency departments with acute mental health crises, and the current state of (mis)understandings among the general public and among practicing clinicians about the promise of means restriction (i.e., reducing access to firearms) as a way to save lives.

Wednesday, May 6, 1:30-3 PM Eastern, 10:30-Noon Pacific
David Healy, MD (McMaster University)
Title: How to Tell if a Drug is Causing Suicide and What to Do Next

Description: Clinical practice is judicial in nature. This means that establishing what is going on depends on engaging with a person and working out how best to explain the problem they have. The “scientific” literature is not much help in this respect. The challenge is to get to an objective position shared by the affected person, a mental health professional and ideally others. This workshop will take participants through this process and outline strategies for working through objections that may arise with the persons and clinicians involved.

Thursday, June 4, 1:30-3 PM Eastern, 10:30-Noon Pacific
Kimberly Repp, PhD, MPH (Washington County OR Public Health Department)
Title: If You Want to Save Lives, Start with the Dead: An Innovative Approach to Reducing Suicide

Description: For the third year in a row, U.S. life expectancy has lowered due to loss of life from suicides. Often, suicide prevention activities are implemented without the data necessary to tailor and target interventions, leading to an ineffective use of very limited resources. To change the direction of this trend, Washington County, Oregon created a nationally awarded suicide surveillance system. This suicide surveillance system facilitates the collection of risk factors and circumstances surrounding every suicide in the county within 48 hours of the death. The risk factors collected parallel those in the National Violent Death Reporting System, such as previous attempts, depressed mood, crisis, legal problems, etc., but without the multi-year data delay and with data reported by the actual forensic death investigator who completed the investigation. In conjunction with our suicide fatality review team, this surveillance system has produced demonstrably effective interventions with imminently suicidal people at hotels, animal shelters, and those being evicted, among others. The true value of a surveillance system is measured by whether it leads to prevention or control of adverse events, and Washington County’s population suicide rate has dropped an unprecedented 40%. This course will demonstrate how fast, meaningful and accurate data are shifting the paradigm on how suicide prevention is done.

**Thursday, July 2, 1:30-3 PM Eastern, 10:30-Noon Pacific
Tunchai Redvers, Director of “We Matter” Northern Ontario, Canada
Title: Working with Indigenous People Who Are Dealing with Suicide

Description: We Matter is an Indigenous youth-led and nationally registered non-profit organization committed to Indigenous youth support, hope and life promotion. Our founding project is the We Matter Campaign — a national multi-media campaign in which Indigenous role models and allies from across Canada submit short video, written and artistic messages sharing their own experiences of overcoming hardships, and communicating with Indigenous youth that no matter how hopeless life can feel, there is always a way forward.

**Finalizing date and time

Thursday, August 6, 1:30-3 PM Eastern, 10:30-Noon Pacific
Susan Stefan, JD, Author, Rational Suicide, Irrational Laws: Examining Current Approaches to Suicide in Policy and Law (Oxford University Press 2016)
Title: To Dream the Impossible Dream: How to Actually Help Suicidal Patients Without Having Nightmares about Liability

Description: In this talk, I invite you to question some assumptions you may have about people who are suicidal, challenge entrenched mythology about which provider actions risk or create liability for the suicide of a patient, and provide specific and concrete suggestions about how mental health professionals can best support people struggling with suicide while also protecting against vulnerability to liability. These suggestions are win-win — they enable you to provide better care while reducing your liability exposure.

Thursday, September 3, 1:30-3 PM Eastern, 10:30-Noon Pacific
Sera Davidow, Director, Western Massachusetts Recovery Learning Community
Title: Alternatives to Suicide Groups: Peer Support Strategies When Life is On the Line

Description: This webinar features Sera Davidow, Director of the Western Massachusetts Recovery Learning Community, where the Alternatives to Suicide approach was first developed. Although now a fully formed approach usable by providers, family members, and supporters of all kinds, Alternatives to Suicide originated as a peer-to-peer support group informed by the experiences of many who had ‘been there’ themselves. The groups have now been running for over a decade, and spread to several states in the US, as well as parts of Canada and Australia. This webinar will explore some of the myths about suicide that led up to the need for and development of Alternatives to Suicide, as well as providing an overview of some of the fundamental pieces of what the groups are actually about. Some of the paradoxes of suicide will also be explored including the hard reality that in order to have influence in someone’s life, so often we need to first learn to let go of the idea that we can or should try to control them.

Thursday, October 1, 1:30-3 PM Eastern, 10:30-Noon Pacific
James Greenblatt, MD, Chief Medical Officer, Walden Behavioral Care, Waltham, MA
Title: Suicide Redefined: The Biology of Prevention

Description: Suicide is a public health issue of critical importance, one which merits our best, most focused efforts towards treatment and prevention. This webinar will introduce a biologic framework for suicide prevention, one in which the concept of suicidality as the result of underlying nutritional, genetic, and psychosocial risk factors is explored. Scientific research supporting significant associations between malnutrition, essential fatty acid deficiencies, lithium deficiency, low cholesterol, and suicidality will be reviewed. Studies illustrating the benefits of targeted nutritional augmentation to mitigate risk factors will be presented; evidence-based interventions will be described; and a prevention model centered upon objective biologic measurement and a concept of biochemical individuality will be elucidated.

Thursday, November 5, 1:30-3 PM Eastern, 10:30-Noon Pacific
Chris Hansen, Director, Intentional Peer Support
Title: Intentional Peer Support and Conversations about Suicide

Description: Intentional Peer Support focuses on validating and understanding the feelings and experiences behind thoughts of suicide. Traditional assessment-based practices focus on risk and liability (stopping suicide from happening). This presentation will be about having a conversation where both of us are present and able to benefit, acknowledging the context of what’s happened — past and present — and providing opportunities to explore meaning and possibilities.

Thursday, December 5, 1:30-3 PM Eastern, 10:30-Noon Pacific
Leah Harris, MA, Founder, Shifa Consulting
Title: The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights From Lived Experience

Description: People who’ve been suicidal have been working on many fronts to influence the policy and practice of suicide prevention, care, and response. Leah Harris will share some key principles and insights as a co-contributor to The Way Forward, a 2014 report authored by the Suicide Attempt Survivors Task Force of the National Action Alliance for Suicide Prevention. The guiding principles and recommendations in The Way Forward remain relevant, including peer support as a central part of a non-pathologizing, community-based, collective response.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Sorry but none of this will sort out the horror nightmare in the UK. It will only change if someone like David Healy – sorry my mistake… there is only David Healy here – get’s a post in a position of power. But as things are, he is more likely to get his website taken down for writing about what really causes suicide and the cascade of doctor decision events that lead to it.

    There are creepy trusts popping up every where here intent that their version of all this – assertively backed by UK Psych/BBC – is correct and we should not to gaze or read such true stuff on here and else where being as we might go top ourselves.

    First of all we have to explain to the people who control the likes of: Instagram, Facebook, Twitter what all this is about, and how they are being used. That needs to be done by people they will believe.

    That said, well done Robert Nikkel…. but we still need to get rid of psychiatry and then subject them to the very horror they subjected us to, preferably in one of their hell holes.

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  2. As far as helping suicidal folks, I think what Steve says in this comment is paramount:


    What I need when I’m feeling suicidal is not for someone to “treat” me or fix my problems, but just to say “shit, I feel that way sometimes, too”, or, “it’s really hard to survive the unnatural demands of this modern world”, or really any statement that validates and makes clear that the person’s feelings are normal and okay (and also transient.) Resiliency is built from connection and knowing you aren’t all alone in the dark.

    It seems like Chris Hansen’s webinar might go in that direction.

    Frankly, I could care less about the providers and their liability. Fear for their own asses keeps so many of the “helpers” from actually helping. How is the client supposed to feel safe discussing such thoughts when they know the treatment provider cares only about covering their own ass? In this instance, I want to point to all of the Lyme doctors who have risked their licenses to treat chronic Lyme patients. Dr Joseph Jemsek is one such provider who lost his privileges in North Carolina in 2006, and just sent out an email this morning thanking all of his supporters and announcing that the medical board’s censure had been rescinded! It’s too bad so many providers in the “mental health” industry don’t have the same kind of personal bravery to take on the system and do what’s right for their clients.

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    • KS, it’s not just fear of their azzes,
      it is fear of being “manipulated”. They think of all human interaction as “manipulation”.
      This has led psychiatry and much of psychology to be unable to think of any emotion, and interaction as “real”.
      It would be so beneficial to kids if households/parents had the knowledge of how these practices make a living….milking the human spirit of all it has.
      But sadly, teenagers do not have the knowledge, one only gains it through the navel gazing that pathologizing the human spirit/emotion caused, the self and outward gazing they promote, to cause self doubt and confusion, on top of self doubt and confusion.
      Through much gazing comes the enlightenment that we bought lies/BS to the maximus.
      Then for many of us, we look back and say “holy shit”, I actually participated in this projection of theirs.

      I have no doubt that psychiatry cannot fix itself because THEY ARE the ones that are sick.
      It is phenomenal to realize that it was the aggressor that was ill. It is yet quite common for victims to not see the total picture.
      Isn’t it weird that psychology teaches that victims are usually excusing their oppressors? Or not aware of their oppressor?
      They participate in the very things they preach as being wrong. So rife with contradictions, so rife with irony.

      It is no longer some phenomena once you can see.

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    • “How is the client supposed to feel safe discussing such thoughts when they know the treatment provider cares only about covering their own ass?” And further has the power to literally destroy your life with a telephone call. A question asked by one R D Laing in the doco Didn’t you used to be R D Laing?

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    • Yes. Suicide has been going on long before psychiatric drugs/shocks–or even psychiatry itself existed.

      I do think psychiatry has caused suicide rates to skyrocket. I wasn’t suicidal till the shrinks punished me for my reaction to Anafranil at age 20. 10 mg Haldol that caused seizures and tardive psychosis. My shrink told my friends and family the only reason I experienced these problems was non-compliance. Took the pills religiously but my failure to improve was seen as evidence of my naughtiness. My tearful protests were to no avail. I got kicked out of college.

      I couldn’t talk normally, or enjoy anything. I was told no man could ever love a schizophrenic and I would die a virgin like my great aunt. Everyone yelled at me all the time. After a year I decided we’d all be better off if I died. God wouldn’t answer my prayers for cancer so I felt suicide was necessary.

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  3. In the drug trials submitted to the FDA for zyprexa, it seems that, of those who stayed in the trial, almost 1 in 200 successfully committed suicide, failed attempts were not disclosed. 2/3 abandoned the trial due to intolerable side-effects. Makes you wonder … in some countries it’s still the drug of choice to treat psychosis … it also makes you wonder why, after the shrink fills the prescription, or before, you’re lectured about the so-called chronic brain disease you have …

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    • And they so often exclude those who drop out instead of viewing them as the “treatment failures” that they should be considered. Even within their own rules, these drugs don’t often do the job, so they change the rules to protect the concept.

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      • They made the rules and they have always been rules that virtually a child can change because the rules exist by some made up concept. It is in fact this concept that people cannot aspire to.
        Like a parent with lofty ideals for his child, that is how psychiatry operates.
        Like anything else, I guess it came at a time of vulnerability. A business born.
        Studying suicide is just another trap that they want us to focus on. Do you actually believe a shrink cares about suicide? The only thing he cares about is that his drugs won’t be blamed, or his practice of not providing hope.

        People are not stupid. More and more realize that if they talk to someone, they will be dealt with. It is actually forced suicide. When you tell people that they will be jailed and drugged if admitting to extreme hopelessness, and on top of that, get a lifelong label, then it is being backed into a corner.

        The deaths from psych drugs, are many. The “treatments” are mistreatments. Any hope that people have in psych, they are quickly dashed by the system that pathologizes and itself creates much hopelessness and complete powerlessness in society in general.

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      • They have clozapine as a last resort. According to the prevailing theory (technically only a hypothesis), dopamine D2 blockage is essential to keeping psychosis at bay. If your treatment resistent, clozapine seems to work the best, even though it blocks dopamine much less aggressively than any other antipsychotic … another unexplained paradox …

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          • Hi Steve,
            Today I went to a government office in a small city and half the building was a coffeeshop. A woman in the coffeeshop was sitting where I could see her from the glass entry dividing us. She kept shaking her legs, wringing her hands, moving, jerking, running her hands through her hair.
            I tried not to stare, but it made me be in pain. Because her distress was something she could not hide, yet I can.
            When I looked her way again, she had just got up and left.
            I went outside (I could not stop myself) and saw her across the street, pacing between parked cars.
            My mind told me stories of what she was feeling. I think she just wanted to be free.
            I could hear her mumbling or talking to herself.
            She then walked up some stairs and kind of paced around. I crossed the street and said hello. She acknowledged me, she had been crying.
            I said, “you are not doing good hey” and she said “I don’t know how much longer”, “what do they want me to do” I don’t know where to look”……So I said, “are you on drugs?” “On psych drugs?” And she said “injections”
            I had offered her $20, but she shook her head. I stayed and said a few words. I asked if she had family, and she said “no..well yes, but they don’t want me”.
            I again offered her the 20$ and said, I’m not trying to be nice, but you are a smoker and smokes are pricy, and I don’t mean to hurt your pride, but we all need help”.
            I told her that we all have problems, don’t let appearances fool you.
            I told her I was sorry I could not help to make her feel better.
            She took it.

            It made me so very sad, and I wish I could just look at people and notice and go home.

            I asked if her doctor can’t give her less meds, dumb question.

            Times like that, Idn, it is so sad that meds like that are allowed.
            She was so skinny, not an ounce of fat, she walked with a limp.

            I blurted out to her that perhaps she could notice a bird. I could not find words.
            I hate people giving injections.
            The way she looked, restless, THAT is what people think is MI.
            And docs think THAT is an improvement?

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          • Shrinks consider that an improvement because making people look scary proves how necessary their profession is. It also helps segregate the “mentally ill” from the mainstream and promotes stigma.

            Many a well informed shrink loves stigma, segregation, and visible nerve damage. Great PR for his quackery.

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          • i was repeatedly told
            1. The drugs were correcting a chemical imbalance in my brain.
            2. That they were neuro-protectors to prevent decline.
            3. And they were needed to prevent me from hurting myself and others.
            4. And they were my only hope for independent living and gainful employment.

            All lies I found out. Doubtful any shrinks believe them. Except number 3.

            The real justification behind psychiatry is what I saw in an interview between Stossel and Jaffe. Jaffe told him, “These people will only wind up in institutions anyway.”

            Writing his fellow men and women off as garbage has been the life mission of D.J. Jaffe.

            In the sight of Heaven Jaffe may be judged far less worthy than those HE judges unfit to exist.

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  4. The monster that made me feel most hopeless is psychiatry. First they made suicide illegal, then made it not an offense because keeping dead bodies in jail was not feasible.

    How do we prevent suicide? We can’t. But we can lessen it by not making people feel they need to fix themselves, because that goal can cause the most self doubt and self beating.
    We not only berate ourselves, we look for help that berates us more and then in the hopelessness of trying to attain “recovered”, not just what it looks like to ourselves, but to others.

    Psychiatry and it’s minions have only hopeless words in their arsenal.
    Even words like “recovery” and “hope” are so very full of subliminal messaging.

    Psychiatry left me with anger. But guess what, there are 5 billion posts on the destructive force of anger, ALL geared to the sufferer of anger and all need to be healed.

    Personally I think even if psychiatry left this earth, it is too late. Too many people have been programmed by it’s religion.
    We no longer need shrinks, we have the general population.

    I think if anything can prevent suicide, it is staying away from the MI model, the drugs should be banned, and the cult that teaches it’s kids and others that emotions should only ever be resilient.

    The Failure Of Raising Robots.

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  5. I’m glad this is coming up, and it looks very interesting! I have only one suggestion: let’s see if we can find a way to talk about “people who are suicidal” without lumping them all together and implying there is some “treatment” that is going to “help” all such people. There is a subtle but powerful subtext through most of the titles of the presentations that buys into this idea.

    How about “people who are feeling despair” or “people who are wondering if their life continues to be worth living” or something like that? Or “helping people find hope when their lives seem hopeless to them?” Something that makes it feel like “feeling suicidal” is actually a pretty common experience that doesn’t necessarily reflect anything “wrong” with the person having that experience?

    I think Leah’s title gets to this best: “The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights From Lived Experience.” Hope, wellness, insights… no mention of ‘suicidal people’ at all.

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    • Here’s the problem going on right now:

      “Very concerned about the emerging practice of – particularly in the Netherlands and Belgium and a couple of other European countries and probably any day now in Canada whereby physician assisted suicide – medical euthanasia – is being provided not just for end of life terminally ill patient – which I consider problematic in it own right – but particularly for psychiatric patients who are not terminally ill – who being in these countries – several hundred of them each year being euthanized on request by their treating psychiatrists. The very psychiatrists who were trying to prevent suicide and keep them alive have by law and public policy demand started to provide suicide by lethal injection”

      How many of those people do you think had AKATHISIA?

      The Role of Psychiatrists in the U.S. Eugenics & Sterilization Movements and the Nazi Holocaust


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      • Luckily in my country streetphotobeing the Law doesn’t require keeping statistics on the people who are ‘assisted’ once they ‘consent’ to lethal injections. So I guess we will never know how many of them had akathisia or anything else

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  6. They need courage and understanding of those beyond the suicide topic, not pity . James Hillman was the only one who wrote book about the proper attitude toward suicide, suicidal people. Believing in the power of death over ego, that’s all.

    This culture should stop imposing ego heroism on suicidal people, because this is naive. In monotheistic culture there is no courage toward death…Because god saved us from death, and death just don’t exist. So there’s no death, no topic. And suicidal people are invisible enemies, so they are silenced and destroyed, as excluded by culture, pariahs.

    Psychiatry protects status quo of naive normalcy and their theological assumptions, so they are privileged. People beyond normalcy are invisible, because their wound is incurable, so the are seen as weak. In ego heroism culture we have the right….to win all the time, with everything. But collective ego is no longer able to win with death.

    This empty culture do not even have idea what psyche is, because psyche was wiped out by monotheistic religious roots. People are not even aware that they were robbed. This is tragedy. But not for those with power over unprivileged people. They will tell you to shut up and then they show you the nearest door.

    What is psychiatry? This is a institution for illegal people excluded by culture, without the right to live.
    Ego has power. Political and material, but not psychological.

    Ego cannot win with death. Ego is dependent on the psyche and, consequently, death.

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