Understanding and preventing suicide is often focused on why people want to die—but a Yale researcher is calling for a shift to a more constructive, humanizing starting point. Christine Cha, PhD, stresses the importance of focusing on why many people who feel suicidal keep trying to live.
Cha is a clinical psychologist at Yale School of Medicine, where her research lab is based. She also serves as an associate professor at Yale Child Study Center and the Center for Brain and Mind Health. She notes that suicidal feelings, including despair and pain, are very real and deserving of compassion. Her studies have also shown that focusing on the future can be a powerful way to combat suicidality. She says that many who struggle with suicidal thoughts are also holding onto something, even if it’s small.
Not only risk, but the “daily fight to live”
In a recent thought piece published in the journal Nature Mental Health, Cha notes that traditional approaches to suicide prevention often focus on reducing risk. They aim to lessen motivation to die, and she emphasizes that this work is “indisputably important.” She argues that it’s incomplete, though, since preventing suicide also depends on understanding what keeps a person going.
“Understanding why a crisis emerges may not be as helpful as understanding why a suicidal person may still be willing to give the next minute, hour or day of life a chance,” she says. Cha adds that researchers have shown “disproportionately little curiosity” about these life-leaning processes and whether they can be strengthened over tim
Pain and hope can coexist
Cha shares a powerful example from a suicidal teenager to show that intense distress can exist alongside a pull toward the future. The teen described suicidal lows as “a feeling I get in my chest, [where] everything is loud and chaotic, and it can feel like being caught in a storm with no cover.”
Yet the same teen—who also designed a graphic identity for Cha’s lab—also said, “even if it’s raining now, I have hope that my future will be beautiful rather than scary.” Cha says that ambivalence is common, and that this resonates with her own experiences as a clinician. She also points to something called “future life-oriented processes” that can help someone stay alive minute-to-minute and day-to-day.
Future life-oriented (FLO) processes
Cha defines FLO processes as the thoughts and feelings that people have about the continuation of their lives. They include a strong desire to live. They might also look like:
- a reluctant willingness to hold on a little longer
- curiosity about what tomorrow could be like
- imagining future events (even in small, uncertain ways)
- listing at least one reason for living
- a sense of connection to their future self
She suggests that these processes may be “promising intervention targets,” but notes that suicide researchers haven’t yet organized or tested them in a coordinated way. Her call is to “balance this death-centered field with this life-centered perspective.”
In moments of physical risk, physical safety comes first
Cha is careful to say that focusing on the will to live does not replace urgent, practical safety steps when danger is truly imminent. She writes that in an acute crisis, “stopping someone from dying by suicide always takes priority.”
It’s important to distinguish between immediate danger and more common periods of potential risk. These windows of risk are when strengthening life-oriented processes may be especially helpful.
Next steps & future directions
When looking toward the future of this work, Cha points to new research underway. This includes establishing a new set of research tools to measure FLO processes to:
- capture how people subjectively perceive their future, via real-time surveys
- actively generate FLO thought details, via behavioral coding
- display people’s emotional response to FLO thoughts, via facial expressions, voice features, physiological arousal
- capture neural responses when engaging in FLO processes, via fMRI
“We are moving beyond discrete modalities and merging them in ways that do justice to the complexity of what it means to think and feel about future life,” says Cha. She and her colleagues are testing brief cognitive exercises to enhance young people’s desire to live. They are also working to develop real-time neurofeedback interventions to enhance FLO cognition in suicidal patients.
In her work as a clinician in the Crisis Intervention Center at Yale New Haven Children’s Hospital, Cha uses something called “Collaborative Assessment and Management of Suicidality” or CAMS. She notes that this complements the FLO research that her lab has been pursuing. “It’s a nice example of putting into direct practice some of the insights we’re learning, since CAMS balances a discussion on reasons for dying with reasons for living with suicidal patients.”
Cha adds that most of the teens she sees at the center rate a “non-zero” desire to live in CAMS sessions—and it’s worth taking the time to explore why some rate a one out of ten on a desire to live scale rather than a zero. In her thought piece, she ends on a note of hope saying, “Although a suicidal person may want to die by suicide, they are alive right now. Better understanding what is keeping them anchored to life today may help them remain here tomorrow.”