Suicide and suicide

Suicide and suicide



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Suicide is made up of the Latin words sui, meaning self, and caedere, killing, which means suicide - negative suicide, positive suicide. It means ending your own life. Most of the time I mean active suicide, in which I hang myself, shoot myself, take poison or cut open the arteries. However, suicide can also happen passively, for example by not eating, drinking or using life-sustaining medication.

A suicidal act that is unsuccessful, so I survive, is suicide attempt. These are far more common than accomplished suicides. When someone is in danger of killing themselves, we speak of suicidality.

A case for medicine?

Suicidality can be a case for medicine - but it doesn't have to be. Mentally clear people, who consciously reflect on their condition and no longer want to live, do not concern medicine, to put it casually. It is different if the risk of suicide results from a mental disorder.

Certain psychological disorders pose a high risk of killing yourself. These include: bipolar disorder, borderline syndrome, clinical depression and forms of schizophrenia. Illnesses that are linked to, or result from, strong self-hatred, such as eating and vomiting, can also be warning signs of an impending attempted suicide.

Progressive diseases in which the patient has an increasingly intolerable condition such as multiple sclerosis or muscle wasting can lead to the premature end of life. This also applies to diseases that are associated with the loss of mental responsibility, such as early dementia or Alzheimer's. Here the decision can be made to put an end to it as long as the person concerned can still think clearly.

There is a duty of care for mentally ill and other people who cannot be granted full legal responsibility for their actions in the situation. This also applies to children, and in some cases to drug and alcoholics.

Suicide is not only a topic of medicine, but also of law, psychology, sociology, theology and philosophy. Suicidology is dedicated to suicide, especially from the perspective of psychiatric medicine.

Suicidality

A suicide affects not only the person who commits the act, but also those around him: parents, friends or classmates. These often need therapeutic help. Mourning sometimes takes years, and the bereaved are often traumatized. Anyone who is professionally confronted with suicide, for example nurses, doctors or paramedics, also needs support.

In adolescents in particular, suicide (even fictional) can trigger a pull on friends and strangers who recognize themselves real or supposedly in the motive of the deceased. One example is Goethe's novel "The Sorrows of Young Werther", which triggered a wave of suicides.

Around 10,000 people kill themselves in Germany every year, two thirds of whom are men - ten times more people attempt suicide, especially women and adolescents.

The high rate of "unsuccessful" suicides suggests that they are mostly "cries for help". But be careful: one in three attempts to commit suicide at least one more time, and one in ten is successful.

Risk groups for suicide are primarily men, the elderly, adolescents, homosexuals and young women with a migration background. While there are a number of factors that push suicidality, such as serious illnesses, the breakdown of a life structure or prison, none of these risk factors together explain suicide. The hazard is there beforehand.

Suicide, suicide, suicide?

Lawyers usually speak of suicide because it does not evaluate it. Suicide is often stigmatizing, especially from church circles, but also more concrete, because murder means deliberate (and planned) killing of a person. The British differentiated between self-homicide as morally acceptable and self-murder as morally offensive suicide.

Suicide is the same act, but focuses on the voluntary nature of the decision. A person determines himself and freely about his death.

This positive word creation is directed primarily against the stigma that the Christian churches impose on suicide. According to Christian teaching, all life comes from God and only He has the right to take it. Fundamentalist Christians who flag self-determined death as sin are also the most radical enemies of abortion and even contraception. However, killing other people if they are considered unbelievers certainly allows this teaching.

Church critic Friedrich Nietzsche, on the other hand, glorified "free death at the right time." The philosopher Socrates not only advocated suicide, but also killed himself after the court sentenced him to death and drank a mug of hemlock poison, although he did could have escaped.

Mental illnesses

Today, mental illness is the most common reason for suicide; either the disease itself is the cause of the crime, or it affects the moods that make suicide seem inevitable. Some authors even consider that only one in ten suicides is not caused by a mental disorder.

However, such figures are extremely critical. The diagnosis is almost always made only after attempting suicide or completing suicide. With a completed suicide, however, only friends, acquaintances and relatives can support the diagnosis, and the memory of the bereaved works according to the pattern of meaning: the brain constructs events, behavior or utterances of the dead as clear indications of the end, mixed with self-reproaches and Feelings of guilt - to relieve yourself, the thought that the deceased was out of his way also plays a role. Sometimes there were really signals, but most memories interpret meanings in something that had no meaning in the situation.

When attempting suicide, the high numbers of "mentally impaired" are also problematic. Those who survived an attempt to commit suicide rarely go on as before. The survivor is mostly traumatized, or at least has had an existential cut, after which he has to reorganize his life from scratch. So he's at least mentally confused.

However, the proportion of suicides among those with a previously diagnosed illness is far higher than among people without such disorders. Even mental disorders that are not diagnosed are likely to lead to suicide in many cases.

Especially in the case of triggers such as loss of job, relationship crises or financial disasters, a closer look at the mental state of the person concerned helps. Such factors are only very rarely the cause.

Mental problems often intertwine with external triggers: Perhaps the deceased suffered from borderline syndrome and put pressure on his partner to leave him - and then he made his recurring threats "I will kill myself"; maybe the mountain of debt is that the suicide threw money out the window in manic phases; or the precarious social situation made the person depressed, but he had already had the tendency to depression before.

Clinically depressed people see no meaning in life. There is a leaden weight above everything. They consider themselves worthless and think that they are a burden on their fellow human beings. Her thoughts are always about death and suicide and many take this step. Robert Enke's suicide pushed the depression out of her taboo zone of a society that glorified Winner types.

Psychiatrists argue whether the sufferers can "be forced to their happiness". People who suffer from clinical depression are responsible, in contrast to open psychoses, for example.

The question is whether it is legitimate that a person suffering from depression and who decides to commit suicide with an abysmally negative but clear view of his environment can be prevented from doing so by force.

In general, specialists, i.e. doctors, psychologists and psychiatrists, act negligently, if they do not (!) Refer to a psychiatry as a mentally ill person who announces suicide - even against their express will.

Bipolar disorder is the psychological abnormality with the highest suicide rate. Phases of grandiose intoxication alternate with the hopelessness of the depression. When bipolar people fall into depression after the manic phase, they have often left behind a pile of broken pieces: debt and destroyed relationships further drive latent suicidality.

Even in the stable phases, they become painfully aware that they can never implement the great fantasies of their mania, while the real possibilities seem colorless to them. Ernest Hemmingway is known to have suffered from this disorder and ended his life by putting a shotgun in his mouth and pulling the trigger.

For people suffering from borderline syndrome, the suicidal tendency is part of their disorder. Many of those affected target aggression against their own bodies, and the thought of death always plays a role. Many sufferers themselves describe their illness as suicide in installments.

Whether the game of suicide with Borderliners is used to manipulate others to take care of the Borderliner, whether the Borderliner is looking for a kick to feel his body, just as he abuses drugs and breaks taboos, or whether he does it seriously means - that is difficult to tell apart, least of all by the Borderliner itself.

For example, one of those affected ate yew needles, jumped into a lake with a backpack full of stones, lay down in front of a train to roll away at the last moment, and bit her wrists in a clinic.

The "put on the train" could be interpreted as a dangerous test of courage as in James Dean's "Because they don't know what they are doing", biting the arteries could also be a means to blackmail the doctors. These games can also be just as serious, and that is part of the illness, and many borderliners die from suicide - and here the term is justified because they cannot bear themselves.

Dissocially disturbed people are incapable of empathy. They intimidate others, resolve conflicts with violence and want total control. They feel not only no compassion for others, but also not for themselves. Violence is fun for them, often they have had a long career in prison, in which they only learned to perfect their brutality.

Without loving yourself or others, they lack meaning in life. Dissocial people represent a high proportion of capital criminals such as serial killers. But many with this personality disorder also kill themselves.

Dissocially disturbed people prefer the hard methods. Classical for them would be an (apolitical) killing spree, at the end of which they shoot themselves.

The call for help

The rate of suicide attempts is much higher than that of completed suicides. In many cases there is a conscious or unconscious call for help behind the alleged suicide attempt.

Some methods of killing yourself are almost certain to work. Anyone who lies down in front of a train or shoots himself in the mouth with a large-caliber rifle has no return ticket in reserve. Even those who drive into the forest by car and emit carbon monoxide rarely expect to be saved at the last moment.

On the other side of the spectrum is the woman who swallows medication several times in a dose that is life-threatening but not necessarily fatal - with the bathroom door open and her husband in the living room.

The signal is: I need help, take care of me. The boundary between people who really don't know what to do and emotional blackmail can only be drawn in individual cases.

Some accomplished suicides are cries for help that went wrong. The spouse was late and the dose was fatal.

The relatives face a dilemma. As with the "dogs that bark but don't bite", they may shake their heads at the hundredth "I'll kill myself" or "if I kill myself, it's your fault", but a guarantee that it's empty words does not exist. In the end, some “actors” really commit suicide. Even experts can hardly distinguish between so-called parasuicidal acts and failed attempts to commit suicide.

These "actors" are opposed to the suicide candidates, whose calls for help were heard - whether real or supposedly does not matter for their decision. These are often very sensitive people who repeatedly made others aware of how bad they feel. In the end, they see no way out.

Adolescents and young adults

In retrospect, puberty and the period between 18 and early 20 when young people leave their parents' home seem to be particularly exciting times, but they are also phases of uncertainty, chaotic feelings and the challenge of orienting oneself in the world some don't feel grown.

Suicide is the second leading cause of death among adolescents in Germany, adolescents commit most suicide attempts, and the risk of suicide among young people must therefore be taken seriously.

The most important contacts for young people are people whom they trust from their closest environment: the parents, or in broken families, teachers, social workers and educators as well as friends. Sentences like "I don't want to live" or "There is no place for me here" should be adopted by these trusted persons and offered a conversation.

Understanding is extremely important for young people. It does not matter whether parents, other adults or mentally stable people consider the problems to be easy - it is important that the person concerned perceives them as overwhelming.

Parents could pick up the thread by accepting that the problems seem insoluble to their children, for example by saying, “I understand that you have difficulties at school and at home and that you are overwhelmed with them. If you can't go on like this, let's see how we change the situation. ”The crucial point is the conversation itself.

Whoever suicidal teenagers reveal their intentions should not misunderstand. Suicide is multi-layered, and a single point of contact cannot handle the underlying problems. So professional advisors should definitely be involved; The unprofessional confidante must never give his own interpretations by trying to change the person at risk, telling him how beautiful this world is, etc. He helps by listening. Otherwise, the suicidal quickly seals the bulkheads.

With their death wishes, adolescents mainly turn to peers, trained counselors who work in a team and exchange ideas are therefore the best counselors for them.

The social development of neoliberalism promotes suicidal ideas instead of alleviating them. Young people are exposed to extreme pressure to perform at school and learn that they are worth nothing if they are not among the "best".

Social research speaks of a generation of egotacticians who learn early on how to place their ego as profitably as possible. This euphemism disguises the fact that children are already being treated for stress symptoms that were called managerial illnesses 20 years ago, that the Borderline suicidal disorder even inspires the symbolic culture of a subculture that inspires “emos”, diseases that arise from the delusion of performance and adaptation Bulemia and anorexia are on the increase, and that suicide thoughts of adolescents are exploding as well as suicide attempts.

The mantra of those who have made it is the sermon on the head of capitalism freed from all ties, and individualistic psychologists as preachers of this anti-social ideology deny social conditions; consequently, they only examine the surface of the factors for suicidality among adolescents: intoxicating drinking, immigration background, ADHD diagnoses, separation of parents, neglected upbringing or refusal to go to school.

Why someone refuses to go to school, why someone drinks, why the migration background can be a trigger for the risk of suicide remains (intentionally?) Hidden behind a veil, and yet is clearly visible.

Anyone who learns early on that school simply means stuffing knowledge that can be retrieved until vomiting (pupils found the appropriate term learning Bulemia) and making their right to exist dependent on the numbers on the certificate has the best reason to do so deny. If he then drinks because he cannot bear this coercive system, it is logical. If the parents then separate and he can no longer keep up with the “delusional upbringing”, ie the lack of extra-curricular tutoring etc. in the delusion of achievement, but also no alternatives outside the hamster wheel, then suicide may appear as the last vanishing point at some point of self-determination.

“Therapies” that aim to adapt the passive resistance to the system negate its will for self-determination. Freedom in which the adolescent can articulate criticism, however, helps him to positively transform his “death wishes”, which are actually desires for a fulfilled life.

The affect

Some suicides happen in affect and / or in psychoses, which act like intensified affects in which all control is suspended. Survivors report such short-circuit actions.

For example, a woman jumped out of the eighth floor of a hospital - first she was on medication and the second was psychiatric treatment. Although she could remember that in the situation she "didn't want" anymore, she described the process from opening the window to the impact as "like in another world", so she had not planned this decision and saw survival as a gift.

Even people who show no psychiatric symptoms commit suicide that they later regret. Psychologically unstable people who act impulsively instead of analyzing and reflecting on situations are particularly at risk.

If personal disasters accumulate with them, suicide is an emergency brake: the girlfriend separates, the study fails or a life structure ends. The person concerned sees a mountain of problems outside and inside of himself, which he would have to remove bit by bit. At least that's how outsiders see it.

Even in less critical situations, he escaped by fleeing; he escaped in love affairs, in drugs, or he changed the city. Now the fear of facing the challenge is overpowering.

Such vulnerable people with an unstable character do not really want to die. They just see no way out and are helpless to change a situation. Of all suicides, they offer the greatest potential for psychotherapy, which supports them in gradually trusting their own strength.

Ideally, such a therapy starts before people with a fragile nerve structure attempt suicide for the first time, and the person concerned learns - at best - to block their escape routes and tackle problems.

The political suicide

"Better dead than slave" is an old battle cry from farmers on the Frisian North Sea coast. Death by one's own hand so as not to surrender to the enemy and to maintain one's own freedom has a long tradition and is considered an honorable form of killing oneself across cultures.

In some cultures, however, this suicide is not an individual decision: In the Second World War, so-called kamikaze pilots flew Japanese planes as living weapons against the Americans. A pilot who crashed survived in American captivity; he never went back to Japan and it was only fifty years after the end of the war that he spoke of his story in public for the first time: alone because he had survived and been captured, he brought shame on his family. This compulsion to commit suicide has as little to do with a freely chosen death as the death of soldiers who burn officers as cannon fodder.

Japan also knows the Sepukku, a cruel way of killing itself to restore a lost honor. The "dishonorable" rams a shear into his lower abdomen and cuts through the internal organs according to a fixed ritual.

In many elite units and secret services, the cyanide pill is an integral part of the equipment. Anyone who works for such organizations is ready to kill themselves if they fall into the hands of the enemy.

Some mass suicides are also acts of war. The Zealots made world history in the Masada mountain fortress. The fortress was considered impregnable, and the Zealots constituted the hard core of resistance to the Roman invaders. They were locked in, the Romans built sophisticated machines to take the fortress, but when they overcame the walls, they found only bodies. The Zealots had cut their throats.

The Zealots created a powerful symbol. Ultimately, rule rests on the power to decide about life and death. If freedom is even more important than one's own life, rule loses its power. In the strictest sense, this type of suicide is not suicide. The individual life of those who kill themselves is wiped out, but the idea for which they stand lives on precisely because of this. It remains to be seen how voluntarily the individual died, because in such hopeless situations the pressure of the group is decisive.

The other side also knew political suicide. The Romans glorified suicide with honorable motives as "Roman death", they even demanded it from high-ranking military officers and dignitaries.

The Roman general, who plunges his sword, is not a literary fiction, but was a widespread practice. For example, the Roman officers who lost to the Germanic warriors in the Varus battle committed suicide. However, this was not considered to be honorable. Because the motive was fear of being captured and, at least for Varus himself, facing the Roman emperor, who would probably also have punished him with death.

Indian cultures saw it as a special honor for warriors to sacrifice themselves for the group. An old coman who stayed alone and faced the enemy did not die by himself, but committed a form of suicide.

It was widespread among the Inuit that the elderly and the sick, who could no longer go with the group, put an end to their lives themselves.

Prevention

People at risk of suicide in modern societies have great problems talking about their thoughts of suicide, either because they are ashamed of it, because they are afraid of being mentally ill, or because they are developing these thoughts because they are Lost contact with other people and see a wall between themselves and their fellow man, or because they have already made the decision. They are often afraid of going to psychiatry and losing the last thing that is left to them - their own decision about their life.

Especially in the phase when they consciously plan their death, suicides often appear very clear. People who previously experienced their friends as unstable, whom they "worried" about, suddenly seem to have their life under control. They visit old friends and have in-depth conversations with them, or they seek out old love affairs to clarify open questions about the relationship - relatives are often pleasantly surprised. Sometimes the suicides give away important books or memorabilia.

However, the “positive lifestyle” that surprises the friends is a warning sign. The person concerned has made a decision. The problems that burdened him no longer matter because he will soon leave this world; he clarifies open questions to say goodbye. Before committing a crime, suicides see doctors more often than usual, but they often fail to recognize the danger.

Prevention is difficult, but possible. Above all, this includes unbureaucratic treatments, further training for teachers, nurses, doctors and therapists to identify a risk of suicide and an open approach in society and the media to the topic.

People at risk of suicide can be helped if they want to. The threshold for this is usually large. Many people at risk of suicide regard suicidal thoughts as the most intimate thing they have. They often fail to see that they need professional help or can be helped with it. It is easiest to convince them if the suicidal idea corresponds to the cry for help.

The treatment depends on the problem. Does the person surrender to his life situation? Does he live in a Messie apartment, doesn't he know how and where to find his job? Then maybe assisted living and the gradual introduction to practical tasks in everyday life, through which he realizes that he can cope, will help.

The media have a special responsibility. For example, after Robert Enke's death, there was a wave of suicides following the same pattern. Media that are aware of the responsibility should report on the causes of suicides in a critical and differentiated manner, without demonizing or glorifying suicide, but also showing who the vulnerable can turn to and what alternatives there are.

Almost everyone who attempted suicide received medical treatment in the previous months, especially from their family doctor. Every third doctor was surprised by the suicide act. After the attempt, almost all suicides are in some kind of medical treatment, be it psychotherapy, psychiatry, an intensive care unit, or a rehab clinic.

C.H. Reimer sees a problem in the fact that doctors and nurses have a negative attitude towards suicide patients. They often still separated between serious suicide attempts that they respect and "simulants" who want to make themselves important. Dealing with suicide patients is not an integral part of medical studies and nursing professions. Doctors often delegated patient psychological care to professionals, psychotherapists and psychiatrists. This is dangerous, however, because the suicidal person deals primarily with "normal" doctors and nurses and reacts to the "purely medical" treatment of his suffering by agreeing on himself.

Doctors, nurses, relatives, friends and colleagues react to the attempted suicide with fear, which often does not admit to themselves: they feel overwhelmed, gnaw guilty feelings that they transfer to the patient, they deal with their own death. In addition, many survivors refuse to speak about their attempted suicide; if it was not a "cry for help" and someone else saved her, the rescue happened against her will. Doctors and nurses then feel rejected by the patient and react accordingly.

First, the doctor must recognize and assess suicidality. Unfortunately, this is usually the responsibility of the family doctor, who has no training whatsoever. Freiburg psychiatrist Bochnik estimates that errors in diagnosis and treatment are responsible for 7000 suicides per year.

Phases of suicide

The following phases usually precede suicide:

In Phase 1 the suicide plays with suicide as a possible conflict resolution. Famous suicides or suicides in the personal environment strengthen these thoughts, but also auto aggression.

Mind games like this are very common among adolescents, for example, as a defiant self-assertion "before I adjust, I put a bullet in my head", as a romantic black fantasy "I cut my wrists in lukewarm water and listen to my favorite CD ”- be it as the ultima ratio“ there is always a way out ”.

When “local heroes” from youth milieus who suffer particularly from social and psychological problems, for example in homes or with street children, kill themselves, every effort must be made to offer help at the lowest threshold.

The Phase II indicates ambivalence. The advantages and disadvantages of suicide are interrelated. The victim sometimes announces suicide "I'm going to stop", "I don't want to live ..." and looks at how his surroundings react.

Such announcements are usually not taken seriously, especially among teenagers, according to the motto "stop feeling sorry for yourself". This assessment is fatal: 8 out of 10 suicides announce suicide, sometimes shortly before, but in some cases for years: For example, a man at 18 said he did not want to get older than 34, and on his 34th birthday he brought around.

Phase III is the decision. Now the decision has been made to either die or live. Diese Ruhephase ist trügerisch. Der Betroffene spricht nicht mehr über Selbstmord. Manchmal hat er mit dem Gedanken daran abgeschlossen hat; häufiger jedoch plant er seinen Abgang jetzt konkret. Angehörige, Freunde und Ärzte sollten jetzt unbedingt mit ihm darüber reden, warum er nicht mehr über Selbstmord spricht.

Wer sich bewusst für das Leben entschieden hat, redet meistens gerne darüber. Wer sich für den Tod entschieden hat, gibt das selten zu, sendet aber durch sein Verhalten eindeutige Signale: „Ist doch klar, oder?“, „warum soll ich darüber reden?“, „entweder man macht es oder man lässt es bleiben“, „die Entscheidung ist gefallen“, „es gibt kein Zurück“ …

Falls jemand möglicherweise in Suizidgefahr schwebt, ohne darüber zu reden, können Freunde, Angehörige und Ärzte ihn darauf behutsam ansprechen. Anzeichen sind zum Beispiel:

– er zieht sich von Freunden zurück

– er leidet unter Depressionen

– er verwickelt sich in Selbstzerstörungen, läuft bei Rot über die Ampel zwischen fahrende Autos, provoziert Gewalt gegen sich selbst, lässt die Kerzen brennen, während er in der Holzhütte schläft…

– in der Vergangenheit erlitt er mysteriöse „Unfälle“

– beschäftigt sich mit spirituellen Themen, die um das Jenseits, Selbstmord, Beerdigung etc. kreisen, ohne dies zuvor getan zu haben

– wirkt merkwürdig „kindlich“, sucht Orte seiner Vergangenheit auf, besucht Personen, mit denen er längst keinen Kontakt mehr hatte…

Die Phasen der Suizidalität laufen nicht notwendig bewusst: Oft stößt der Gefährdete in seinen Nachtträumen und Tagesfantasien immer wieder auf bizarre Todesarten, Nachrichten über Selbstmörder ziehen ihn magisch an; dann verdichten sich diese Bilder seines Unbewussten, entwickeln ein Muster, das andere, das Leben bejahende Muster ersetzt – und die Konstruktionen des Unbewussten erscheinen dem Betroffenen immer mehr als die eine Wirklichkeit.

Besondere Aufmerksamkeit gilt, wenn der Betroffene zuvor bereits parasuizidal handelte, damit sind „misssglückte Selbstmordversuche“ gemeint, die Selbstmord zitierten, aber nicht lethal enden sollten. Das alles sind Appelle, sich um sein Problem zu kümmern – eine nonverbale Kommunikation.

Besondere Risikofaktoren sind:

– Lebenskrisen bei Krisenanfälligen

– suizidale Entwicklung

– präsuizidales Syndrom

– Depressionen

– Alkoholismus, Drogen- und Medikamentsucht

– Alter und Vereinsamung

– Suizidankündigungen- und versuche

Fragen, die an den möglichen Suizidkandidaten gestellt werden können, sind:

Hat der Betroffene versucht, sich das Leben zu nehmen? Hat er es schon vorbereitet? Hat er Zwangsgedanken an Selbstmord? Unterdrückt er Aggressionen gegen bestimmte Personen? Erlebte er Krisen, die er nicht verarbeitet hat? Ist er traumatisiert? Hat er seine Kontakte zu anderen Menschen reduziert?

Hinterbliebene eines Suizidalen, dem sie halfen, der sich aber doch tötete, sollten ihre Möglichkeiten im Nachhinein nicht überschätzen: Wer sich bewusst entscheidet, von eigener Hand zu sterben, der wird es irgendwann tun. Wenn er bei klarem Verstand war, ist der letzte Respekt ihm gegenüber, seine Entscheidung zu akzeptieren. Vor einem Suizid schützt nur die Entscheidung für das Leben. (Dr. Utz Anhalt)

Literaturtipps:

Anlaufstellen für Suizid-Gefährdete:
Onlineberatung für Gefährdete unter 25 Jahren: www.u25-freiburg.de
– www.krisen-intervention.de/suizikrs.html

Abram A, Berkmeier B, Kluge K-J.: Suizid im Jugendalter. Teil I: “Es tut weh, zu leben”. Darstellung des Phänomens aus pädagogischer Sicht. München 1980

Aebischer-Crettol E.: Aus zwei Booten wird ein Floß – Suizid und Todessehnsucht: Erklärungsmodell, Prävention und Begleitung. Zürich 2000

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