Grief after Suicide: Walking the Journey with Survivors
Webinar Description: The Grief after Suicide: Walking the Journey with Survivors
webinar was presented by John Jordan, Ph.D., FT, a licensed psychologist in private
practice in Wellesley, MA, and Pawtucket, RI, who specializes in working with loss and
bereavement. This webinar discussed some of the unique challenges of suicide loss for
mourners and for those who would help them. In this webinar, Dr. Jordan addressed
some of the central concerns that most survivors bring to therapy, and the themes that
caregivers must help survivors address. At the end of this webinar, participants will be
able to:
1. Identify at least four themes in bereavement after suicide.
2. Describe common psychological recovery tasks for suicide survivors.
3. Identify broad clinical guidelines for work with mourners after a suicide.
Webinar Duration: Approximately 89 minutes
Brandy Brooks: Good afternoon and welcome to the Grief after Suicide: Walking the
Journey with Survivors webinar. My name is Brandy Brooks and, aside from being the
moderator this afternoon, I am a Contract Manager for the Massachusetts Department of
Public Health Suicide prevention Program, the sponsors of this webinar.
Before I introduce our presenter, Dr. Jack Jordan, I would like to go over a few
housekeeping issues. First, to view video for this webinar, go to www.readytalk.com and
enter access code 6245494 to join this webinar.
Additionally to listen to the audio portion for this webinar, you need to dial 1-866-7401260. Again, that’s 1-866-740-1260 and you need to enter the access code 6245494.
Also, should you experience any technical difficulties with either the audio or video for
this webinar, please dial 1-800-843-9166. Again, that’s 1-800-843-9166 and a ReadyTalk
representative will be more than happy to help.
Secondly, all telephones are muted except mine and Dr. Jordan’s. So, please use the chat
function located in the left corner to type any questions you may have. Given the number
of participants, Dr. Jordan will do his very best to answer as many questions as possible
as we go along and at the end of the webinar during the question and answer period.
Now that I’ve gotten that out of the way, let me introduce our presenter, Dr. Jordan. Dr.
Jack Jordan is a licensed psychologist in private practice in the Wellesley, Massachusetts
and Pawtucket, Rhode Island where he specializes in working with loss and bereavement.
He was also the Founder and Director, until 2007, of the Family Loss Project, a research
and clinical practice providing services for bereaved families. He has specialized in work
with survivors of suicide and other losses for more than 30 years.
As a Fellow in Thanatology from the Association for Death Education and Counseling, or
ADEC, Jack maintains an active practice in grief counseling for individuals and couples.
He has run support groups for bereaved parent, young widows and widowers, and suicide
survivors with the latter running for over 13 years.
Dr. Jordan is the clinical consultant for Grief Support Services of the Samaritans in
Boston, where he is helping to develop innovative outreach and support programs for
suicide survivors. In 2011, Dr. Jordan was the co-recipient of the Leaders in Suicide
Prevention Award from the Massachusetts Coalition for Suicide Prevention for his work
with the Grief Support Services at Samaritans. He is also the professional advisor to the
Survivor Council of the American Foundation for Suicide Prevention, or AFSP, and a
former Board member of AFSP and ADEC.
In 2006, Dr. Jordan was invited to become a member of the international workgroup on
death, dying, and bereavement and was the recipient of the ADEC 2006 Research
Recognition Award. Dr. Jordan has been involved in several research projects on the
needs of people grieving after suicide and, in 2004, received research funding from
AFSP.
He has also provided training nationally and internationally for therapists, healthcare
professionals, and clergy through PESI Healthcare, CMI Education, the American
Foundation for Suicide Prevention, and as an independent speaker. He has also helped to
organize and lead many healing workshops for suicide survivors.
Dr. Jordan has published over 35 clinical and research articles, chapters, and full books in
the areas of bereavement after suicide, support group models, the integration of research
and practice in thanatology, and loss in family and larger social systems. He is published
in professional journals, such as Omega, Death Studies, Suicide and Life-Threatening
Behavior, Psychiatric Annals, Crisis, Grief Matters, and Family Process.
He is also the co-author, with Bob Baugher, of After Suicide Loss: Coping with your
Grief, a book on suicide bereavement for surviving friends and family. He is also the coeditor, with John McIntosh, of the new book, Grief after Suicide: Coping with the
Consequences and Caring for the Survivors, a professional book on the impact of suicide
and intervention to help suicide survivors.
So now, without further ado, I will now turn it over to Dr. Jordan. Dr. Jordan, are you
there?
Jack Jordan: Yes I am.
Brandy Brooks: Okay.
Jack Jordan: Thanks very much, Brandy. I’d like to extend a warm welcome to all of
you for joining us for the webinar today. I really appreciate your joining us because
talking about suicide is a difficult topic, I know, and doing the work with survivors can
be a difficult topic.
Let me just actually say a word about definition and also a word to survivors who may be
listening. Sometimes the word ‘suicide survivor’ can be a confusing choice of words or
language because logically it could mean, when we say ‘suicide survivor’, it could mean
someone who has attempted suicide and survived the attempt. But, within suicidology
and particularly in North America, a ‘suicide survivor’ has come to mean someone who
is grieving intensely after the loss of someone important to them to suicide. That’s the
way I will be using it today. In other words, a survivor is someone who is grieving after a
suicide, not somebody who has attempted suicide. If I’m talking about someone who has
attempted, I’ll use the word ‘attemptor’.
I also want to say something to those of you who may be survivors who are listening,
whether you’re a survivor or whether you’re a clinician and a survivor also. I know it can
be difficult sometimes to hear a more academic professional talk about something that is
so intensely painful and personal. I would ask each of you who are survivors to do two
things.
One is to listen to what I have to say and take it with a grain of salt because, of necessity,
I will have to make a lot of generalizations about what the experience is for people after
suicide or what might be helpful for them. You may or may not find that it’s for you or
what your experience was. The second thing is just to take care of yourself. Sometimes
listening to ideas or hearing a clinician present about suicide bereavement can be
triggering so I want you to do whatever you need to do to take care of yourself
emotionally.
In terms of my own background, in addition to what Brandy said about being in private
practice and doing just a great deal of work over the last 30 years with bereavement in
general and with suicide survivors in particular, I think of myself and call myself a distant
suicide survivor. I did have a great-uncle die in 1987 of suicide. I also had one patient
take their life, early in my practice. This was a situation where I saw a couple in therapy
for a while and then they decided to stop the therapy and the marriage. A couple of
months after that, the husband took his life and the wife came back to see me for a while
after that.
Both of those were sad experiences for me but, honestly, they were not life-transforming
experiences for me. Many of the people that I work with, many of the people that you
may work with in whatever setting you do your work will be people whose lives will be
profoundly transformed or changed by the loss of their loved one to suicide.
Really, I feel that most of what I have learned about the experience comes from my
having walked the journey -- that’s why I call the webinar what I call it -- from having
walked the journey, at this point in my life, with hundreds of survivors. That’s a little bit
of background about myself, both personally and professionally. Brandy essentially read
my bio to you.
Let’s talk a little bit about what we’re going to try to cover today and let’s see if I can get
the technology right and move us to the second slide. There we go. I just gave you the
introduction.
I’m going to spend a very short amount of time on what I call Suicide 101, which is just a
little bit of background about suicide in America. I do that because, if you're going to
work with survivors, it’s important that you have an understanding of what some of the
forces are that lead to suicide. One of the tasks that survivors face is to make sense of a
death that often doesn’t make any sense. One of the things I try to encourage survivors to
do is to educate themselves about suicide. I want to give you just a little bit of
background information about suicide.
We’re going to talk about the experience of losing someone to suicide and what we know
about what the impact can be on people. I’m going to talk some about recovery tasks for
survivors; some of the psychological work that I think survivors need to do to heal. I’ll
conclude with some guidelines, broad guidelines, that really kind of incorporate
everything that I’m going to be saying today in the webinar for you to keep in mind when
you're doing counseling or clinical work with survivors.
I can take questions throughout the webinar if, as Brandy said, I’ll do my best to try to
answer as many as I can. I can’t promise that we’ll have time to get to all of the questions
but I’ll do my best to answer as many as I can.
Okay, let’s talk a little bit further about the definition of who is a survivor and what I call
survivorhood. In the past, particularly in terms of research, there hasn’t been a really
clear definition of; what do we mean by a survivor? Sometimes some studies have
referred to a survivor as anybody who’s been exposed to a suicide. In other words; have
you known somebody who’s died by suicide? We know that over the course of their
lifetime about two-thirds to three-quarters of Americans will, at some point in their life,
knows somebody who dies by suicide.
The most common definition is probably the second one here which is a kinship
relationship. In other words, survivors are typically thought of as the immediate family of
the person who died by suicide. More recent studies have looked at psychological
closeness to the deceased, regardless of whether they were blood kin or not to them; for
example, studies that look at the friends of an adolescent who takes their life who may
have been close friends of that young person.
In the book that John McIntosh and I have just published, called Grief after Suicide, it’s
on your reading list, we try to offer a definition that we think is both broad and narrow, in
a sense. The definition is that a suicide survivor is someone who experiences a high level
of self-perceived psychological, physical, and/or social distress for a considerable length
of time as a result of the suicide of another person.
That definition is both broad, in that it does not presume that survivors are only the kin,
only the immediate family of people. It could be anyone in the social network of someone
who dies by suicide. It could even be someone who was not in that person’s social
network.
Just as a hypothetical example, if someone were to jump in front of a subway train, the
driver of that subway train may be deeply impacted by that. They may be very
traumatized by that experience. In that sense, it might meet this definition of being a
suicide survivor even though that’s not the kind of person we normally would think of as
needing clinical services or that support groups would be designed around helping. But,
they may be somebody who’s profoundly impacted by the suicide of this person.
It also does not presume that, because someone is kin or close to the person, that
automatically that they're going to have a difficult time so that we’ve included in this
definition that a high level of distress that persists for period of time is part of the
definition.
Alright, moving on; a little bit of Suicide 101, of suicide epidemiology. I would like
everyone listening to this call to please understand that suicide is a public health issue in
the United States. There has been a real see change going on in the last 20 to 25 years in
the United States.
Traditionally suicide has been understood as a private event that happens in a family that
mostly the community doesn’t talk about or they talk about behind closed doors. But, it’s
seen as sort of something that happens in a family but it doesn’t have anything to do with
the rest of our communities. It’s just sort of a dysfunctional behavior by an individual,
maybe from a dysfunctional family, but has nothing to do with the rest of us.
There’s been a very strong and growing effort to understand suicide as a public health
issue in the same way that violence or AIDS or other behaviors and illnesses that impact
the whole community need to be seen as public health problems and a public health
approach can make an impact on that.
There are, around the world, there are about 1 million people a year who die by suicide
and that’s quite probably and underestimate of the true number. There are more people
who die of suicide around the world than die of war and homicide combined. There are
about as many people who die of suicide around the world as die of AIDS around the
world. When you think about the amount of public health attention that has been given to
AIDS, and I’m not bemoaning that at all, but when you look at the amount of public
health attention that has been given to AIDS versus the amount of public health attention
that has been given to suicide, the latter pales in comparison.
In the United States there are about 36,000 official suicide completions a year. I say
official because, again, it’s probably an underestimate of the true number. We don’t have
good data about the number of attempts a year but our best estimates are that for every
completion there are probably 20 to 25 attempts so there’s probably 800,000 to 900,000
attempts a year in the United States.
Suicide is the tenth leading cause of death in the United States. It is the third leading
cause of death for young people, meaning people in the age range from 15 to 24. Males
complete suicide at a rate that’s about four times that of females. Females attempt suicide
more often than males but males are much more likely to actually complete suicide.
Very important, about 90% of people who die by suicide, at the time of their death have a
diagnosable, unfortunately often undiagnosed and untreated, but they would meet criteria
for having a psychiatric disorder, most often mood disorders; clinical depression or
bipolar disorder
I want to talk a little bit about who is a survivor. How many survivors are there? What are
some of the common themes that survivors experience in their grief? And what is the
impact of suicide on family systems, not just on individuals?
A common statistic that has been kind of thrown around for years, it really came from
Edwin Shneidman, who is the grandfather of suicidology in America. He once said that
for every suicide there are at least six survivors. The problem is that Ed was simply
making a guesstimate. He really had no empirical data that he was basing that on. It was
just his best guess about how many people were likely to be impacted by a suicide. If we
took that figure alone that would mean that there were about 180,000 maybe 200,000 new
survivors a year in the United States.
We don’t actually have good data on how many survivors there are because, as I said
earlier in the presentation, many studies have not clearly defined how they have delimited
who is a survivor; how you would count that. Before you count something you have to be
able to define it. What we do now have is some data about exposure to suicide.
Remember that exposure to suicide is different becoming a survivor, at least in the
definition that I offered. Exposure means that you’ve known somebody who’s died by
suicide but that may or may not have a profound impact on you.
In 2002, Alex Crosby and Sacks did a very well-designed, large telephone survey of
households in the U.S. and -- I don’t remember the exact number but I believe there were
7,000 or 8,000 households that they surveyed -- and extrapolated from that to the general
U.S. population. They found, based on their survey data, that approximately 7% of the
U.S. population will report that they’ve been exposed to someone in their social network
who has died of suicide within the last year. So, about 21 million people a year know
somebody who dies by suicide in the United States. About 1.1% of the U.S. population
will report that they’ve lost a family member, which would translate to a little over 3
million people a year.
Of people who have been exposed, about 3.2% report they’ve lost an immediate family
member; a brother or a sister, a parent, a spouse, a child. Not quite 14% report that
they’ve lost an extended family; a cousin, an aunt, an uncle, a grandparent. As you would
expect, about 80% of people report that they’ve lost a friend or an acquaintance. Again,
this could be someone that they knew at work, just barely knew just somewhere in their
social network.
But, this begins to give us some idea of the number of people who, at least, are exposed.
Of that population of people who are exposed, we don’t really have good data about how
many of those people will go on to have a very difficult time.
There has only really been one study that had been done that’s tried to look at that and the
methodology was somewhat suspect. That study found that if we’re just talking about
immediate family, yes, the 5 or 6 figure may be about right; that for every suicide, on
average about 5 to 6 immediate family members are significantly impacted. If we’re
talking about the entire social network, we may be looking at something more like 30 or
40 people are fairly significantly impacted. We need a lot more research on that.
So what are some of the prominent themes for suicide survivors? What’s the impact on
families? And are there even some positive effects of losing someone to suicide,
psychologically? What the field is calling post-traumatic growth.
Again, for those of you who are survivors, I want you take what I’m about to say with a
grain of salt. It may or may not have been what you have experienced.
The first two items; let me see if I can use the technology here and just mark these. There
we go. The question of “Why did this happen?” and the need to make sense of this and
closely correlated with that or related to that is the question of assigning responsibility for
the death. The issues of guilt and blame about it are very, very powerful for suicide
survivors and are usually not nearly as prominent after most other kinds of deaths. They
can be after other traumatic deaths. For example, in a homicide, certainly the issue about
responsibility and blame are very prominent themes for survivors of a homicide loss.
The ‘why’ question is pervasive for most suicide survivors. Suicide is inherently a
mysterious and frightening and confusing cause of death. The general public does not
have -- collectively as a society, we do not have a narrative about why suicide happens
and why people take their life. So, when it happens it’s frightening and confusing for
people.
We’re also not clear about whether suicide is something that people choose out of their
own free will. In other words, “Is this a voluntary act?” Or is it something that people are
driven to, either because of circumstances; they're overwhelmed with stress events in
their life, or because of a psychiatric disorder?
I would suggest to you that, and I’ve come to think about suicide as the perfect storm. It
is the coming together of multiple factors in just the wrong way that create the conditions
that allow suicide to happen. Those factors range from everything from the individual’s
neurobiology. -- there’s a growing amount of evidence that psychiatric disorders and
suicide itself may have some genetic component to them and involve neurobiological
disregulation on the part of individuals and the public generally doesn’t understand that -to certainly stressor event play a role in creating the conditions that allow for suicide. Life
experience does. For example, people who’ve had a history of having been abused,
particularly sexually abused, repeatedly as a child have an elevated rate of risk for suicide
over their lifetimes so that life traumas and events can contribute to this.
It really is the coming together of multiple factors. In my experience, suicide is never the
result of just one thing even though people in social networks, society, want to have a
simple explanation. “Oh, he killed himself because he lost his job.” “He killed himself
because his wife left him” Kind of simple one-sentence explanations of why someone
does something. But, suicide is a very complex phenomenon and is multi-determined.
One of the tasks for survivors is come to develop a sort of rich and complex narrative of
what happened to their loved one. Related to that is the issue about, “What role did I or
did other people have in this tragic event?” As I said a minute ago, people tend to be
confused about; is this something that people choose or not? I would suggest to you that
there’s no simple answer to that either. Clearly when people are suffering from severe
psychiatric disorders, schizophrenia or a psychotic disorder, people are not regulating
their behavior in any way that we would call choosing or free will. If someone is hearing
command hallucinations and they're hearing voices that say, “You have the Devil in you.
You need to jump off this bridge.” No one would say that that person is making a choice
out of their own free will to end their life.
On the other hand, someone who has a very severe terminal illness; they're in a great deal
of pain, and they say, “I don’t want to go on with this anymore” and they decide to end
their life. Whether you agree with it morally or not, most people would say that person is
making a choice. It may be a choice profoundly influenced by the pain or the
circumstances they're in but there is some degree of choice in that. I would suggest to you
that each suicide differs as to how much choice or free will’s involved. It’s a very
complex phenomenon to just trying to understand what led to a particular suicide.
The third point would be issues about trauma and helplessness. It’s easy to see that
people can be traumatized, and I don’t simply mean traumatized in the sense of very
emotionally upset, that’s obvious but I mean also traumatized clinically in the sense of
post-traumatic stress disorder. It’s kind of easy to see that if someone witnesses the
suicide or discovers the body that that could lead to post-traumatic stress disorder, a kind
of re-living of the horrific experience.
I want to also advise you that people don’t have to have been an eyewitness to the suicide
to be traumatized by it. I’ve worked with far too many people who were not an
eyewitness to their loved one’s suicide but they certainly have developed traumatic
imagery about it. They have nightmares about it. They're haunted by the manner in which
their loved one died. If you're working with survivors, it’s very important to not only ask
about grief and bereavement but to ask about trauma symptoms.
The fourth point is anger. It is normal to feel anger when you lose someone to any cause
of death. It can be particularly normal to feel it when you feel like your loved one has
made some kind of a choice to either reject you or abandon you. This gets into the
construction that the survivor makes about, “Did this person choose to do this or not?”
I’ve worked with many survivors who tell me that they’ve never felt angry about what
has happened and I’ve worked with other survivors who are furious with the person who
took their life and say, “How could they have done this to me? Didn’t they know how
much they would hurt me or hurt their children or hurt their family?”
It’s interesting to note that suicide is -- the Latin root of the word suicide literally means
self-murder. In some ways, the reactions of some suicide survivors are very akin to the
reactions of homicide survivors. If you had your loved one murdered by someone you
can imagine how you might feel about the perpetrator of that murder but, in suicide, you
have a profoundly difficult and confusing conundrum because the, quote-unquote,
perpetrator is also the victim. That makes for a very confusing, conflicting set of
emotions about what has happened. “Should I be furious with this person for doing this or
should I feel sorry for them?” That adds to the kind of merry-go-round of confusing and
conflicting feelings that survivors might experience.
The last one’s relief. I want to, again, be careful about this. In my experience, when
people are blindsided by the suicide; they had no awareness that their loved one might
have been thinking about suicide, you rarely see relief as one of the emotions that people
experience. In contrast to that, when the suicide is the end point of a long downward
spiral, a long struggle with a psychiatric disorder, then you may see relief as one of many
emotions that the person experiences.
I remember working with a couple whose daughter had multiple psychiatric
hospitalizations, had made multiple suicide attempts, and finally, after an attempt in
hospitalization she was discharged then a couple of days later completed suicide. After
the couple went through the first set of religious holidays, I’ll never forget the mother
coming in and saying to me in a very quiet voice, “Actually, Dr. Jordan, it was one of the
best holidays we’d had in years.” Because one of the emotions that that mother felt was
relief that this ordeal, both for herself and her husband and for her daughter, was over.
It’s really akin to when someone has died a long difficult painful death of cancer, for
example, we give people permission to feel some relief that that ordeal is over. Well, in a
sense, you can think about people’s dying along painful difficult death from bipolar
disorder or depression, but society doesn’t give people permission to have, as one of their
emotions, relief. This mother felt a lot of other emotions including great sorrow, both
about the loss of her daughter and the life that her daughter had led, and she felt a lot of
other complex emotions but one of them was relief. That can happen sometimes.
Shame and also social disruption; most of you probably know that there’s a long history
of stigmatization both of suicide and a psychiatric disorder. In the Middle Ages, the body
of someone who died by suicide was not allowed to be buried in church grounds. The
body was often taken out and mutilated or put in a public place as a warning to other
people. The family was also punished. The family would be shunned. They would be run
out of the village. They were not allowed to inherit the estate of the person who died. So,
there is a long history of punishing the family, punishing the survivors, for what the
deceased has done.
I see that there’s a request to see if I could speak louder. I will see if I can turn up the
volume on my handset on the phone and I will try and speak louder, but hang on just a
second while I try to turn this up. I don’t know if that’s louder or not. I hope that I’ve
turned it up. I will also try to speak a little bit louder.
Social disruption really refers to a change that’s going on. I think there was gradually less
stigma associated with suicide and what’s happening instead is what I call social
ambiguity. When human beings are uncertain about what to do in a given social situation,
what they usually do is they hang back. They hesitate and look for cues about what it is
that they should be doing in that situation that’s appropriate behavior. Most people don’t
know what to do in the presence of someone who’s lost someone to suicide so they
hesitate and may even avoid interacting with that person or they may avoid talking about
the subject of the suicide death, not out of condemnation, but out of discomfort or
awkwardness. Survivors then perceive that avoidance behavior as rejection or
abandonment.
Survivors themselves may feel awkward about it and not know what to say or how to
explain it. You have a kind of a vicious cycle that gets started. Survivors may become
more and more isolated from other people and other people may pull away from
survivors. One of the most valuable things for survivors, at least for many survivors, not
all but many, is being able to talk to other survivors, in the form of face-to-face support
groups, online chat groups, etc. because it helps reduce this profound sense of isolation
that can happen after a suicide.
Suicidality; I get asked sometimes, “My husband took his life, does that now mean that
my children are at risk for suicide?” The short answer to that question is, yes, but only
slightly. We do know that exposure to suicide increases, somewhat, the risk of suicide in
people who have been exposed, particularly immediate family members. Some of that
may be due to, within a family system, to shared genetics. But, even if you lose your
spouse to any cause of death, it increases the risk of suicide simply because of the grief,
but if you lose your spouse to suicide as opposed to other causes of death, it increases the
chances that you will die by suicide even more so. Presumably there’s no shared genetics
there.
So, there is something about being exposed to suicide that has a kind of role-modeling
effect. But, the increasing chances of dying by suicide if you’ve been exposed to it are
not a huge increase. It’s a small increase.
But, I’ve worked with many survivors who do have some suicidal ideation. Sometimes
people will say to me, “I now feel like I understand what my loved one was going
through because this is so painful or difficult for me I can relate to being in a kind of
psychological space in which death seems like it would be easier than carrying on.”
Suicide can raise, for survivors, the question about, “Why do I go on and how can I learn
to survive this, to bear this?” Certainly, of course, suicide can produce profound sorrow,
as do other deaths. If you lose someone to suicide, you miss them and grieve for them
and want them back in your life in the same way that you would grieve for them if they
had died from any other cause.
Let’s go on to the next slide. I see that the volume’s better. Good. Thanks for bringing
that to my attention.
Let’s talk a little bit about the impact of suicide on family systems, not just on individuals
but on the family as a unit. First of all, suicide immediately presents for a family a
problem about information management. “How much are we going to tell other people?
and “Are we going to tell people the truth about what was happened here?” This can be a
very divisive issue in families. There are families in which some members of the family
say, “We have to tell people the truth.” Other people say, “We can’t tell people the truth.
What will people think of us if they know that our husband or our child or our parent died
of suicide?” It can split families. It can be divisive.
It’s not only an issue about, “What do we tell people outside the family?” It’s an issue
about, “What do we tell certain members of the family?” For example, I’m working with
a woman whose husband died by suicide and they had one child who was three years old
at the time. When her husband took his life, she simply told her three year old son,
“Daddy was sick.” but didn’t explain what that meant or why or the circumstances of his
death. The child is now about five and half years old and he’s beginning to ask more
questions about, “Well, how was Daddy sick? What was he sick from? And why did he
die?” She’s struggling with how much and how to tell her child the truth about this.
It’s a very difficult issue for parents. As mental health professionals, we generally want to
encourage parents to be truthful with their children, and that’s what I do, but I also have
empathy for how difficult a discussion that is and the wish to protect your child and
sometimes to want to honor the image of the parent that you want to keep for your child.
In general, what you want to help children do is to develop a relationship with you as
their parent that they feel like the information they are getting is the truth, that they can
count on you, trust you to tell them truth, and that the information is packaged in ways
that’s appropriate for their developmental age. A three or four year old doesn’t
necessarily need to know all the gruesome details of how the person died but they may
need to know that the person acted in a way that ended their own life. Then, when they
get older if they trust the relationship with their parent, they will ask more questions,
typically, and want to know more details about that. You can answer those as the child
gets older.
Secondly, these kinds of deaths, both suicides and other traumatic deaths, can really
disrupt family routines and rituals. Dinner may not get put on the table. Holidays may not
be celebrated. It changes people’s emotional availability to each other. A parent who is
very depressed and saddened may not be able to function in a parental role very well
within a family. Husbands and wives may not be able to be emotionally, sexually,
available to each other, as supports to each other. All of this can be destabilized or
disregulated by the powerful grief that can ensue after a suicide.
It also can change the distance and power configuration within a family system. A parent
who’s used to being an authority figure within the family, the disciplinarian, etc. may
now feel immobilized. A parent may feel like, “I have misjudged my child and they were
suicidal and I didn’t know it. How can I trust my judgment, going forward, about my
other children?” They feel immobilized about making judgments about their other
children or about setting limits with their children.
It can produce a communication shutdown in families. Oftentimes family members are
very worried about each other and, because of that, they're worried about what the impact
is going to be on other people in the family. They will avoid talking about it as a way of
trying to protect everybody. Everybody in the family is trying to protect everybody else.
This, then, leads to a kind of conspiracy of silence about it.
Or, another version of that is that, because there’s a great deal of anger generated by the
suicide and a wish to blame somebody, the family avoids talking about it because they
know, “If we start talking about it we’re going to start blaming each other. We’re going
to turn on each other because we’re angry with somebody in the family about not doing
what they should have done.” It can be potentially very divisive within the family.
Lastly, it can produce what I call coping asynchrony, which is just a fancy way of saying
people grieve with different styles, at different paces, at different speeds. This can be
very problematic in a family system.
Sometimes, I think of a family I worked with in which the adolescent daughter took her
life. The husband was focused really on, “How do I protect the family?” Often a role
fathers are in. “I want to protect my wife and my children from this. I want to protect the
family. I want to get us back up and functioning again as quickly as possible.”
His wife, on the other hand, was really shutting down. She literally had trouble coming
out of the bedroom for several weeks. She couldn’t go by the room in the house, the
daughter’s bedroom, where her daughter had taken her life. She really shut down and she
was just focused on nothing but her daughter and wanting to contact her daughter. She
wanted to see a medium. Nothing else mattered to her but the loss of her daughter.
This began to produce a great deal of tension between the parents. He wanted his wife
functioning back as a wife and a mother in the family and she was basically saying,
literally and metaphorically, “Why can’t you come to the bedroom with me? Why can’t
you join me in my grief? How can you be so focused on functioning when our daughter
has done this in our family?”
That’s a common pattern in families. Families need to give each other, the members, give
each other wide berth to grieve in their own way and their own style without becoming
judgmental about it. Otherwise, it can be very divisive.
What it can lead to is blame and scapegoating, which can be very divisive. When you see
a family that is doing cutoffs or people will not talk to each other or blaming each other
about the suicide. Or, where there’s a lot of overt arguing or fighting about it, that’s a
marker of a family that’s having a very difficult time and needs help.
A suicide can also produce a tremendous amount of anxiety about, “Can this happen
again?” both in a specific way, “Could someone else in the family be suicidal?” and in a
more generic way. We know this about trauma in general, once the trauma has happened
to someone, people will become hyper-vigilant about, “Can the trauma happen again?”
And, just in general, “Can something else bad happen to me? How do I know it won’t
happen again?”
So that normal developmental processes in families -- for example if parents have a child
die by suicide they're likely to be particularly watchful of and clinging to, in some ways,
their other children. It may make it difficult for those children, over the coming months
and years, to separate from their parents.
Likewise, children become hyper-vigilant about their parents, even young children, about
the well-being of their parents. They may have difficulty being able to work on
developing a life for themselves because they see how wounded their parents are after
this. It makes normal family processes of individuating and separating more complicated
for family systems. The result of all of this can be a loss of family cohesion.
I would be remiss if, when I talked about all of these things that can go wrong and be
problematic in a family system and for individuals after suicide, if I didn’t also talk about
what the field is calling post-traumatic growth after suicide. What we mean by that is
really resilience that people show in healing and even becoming stronger, more
compassionate, wiser people after this kind of traumatic experience.
People’s identity will change after a suicide. People will develop a kind of survivor
identity. People have said to me, “If you would have told me two years ago that my child
was going to take their life and that I would still be putting one foot in front of the other, I
would have told you that you were crazy. I couldn’t survive that but I guess I have. I
guess, somehow, I’ve found something in myself I didn’t know was there.” So their
identity has shifted as a result of that.
People change their relationships with other people. Often times people will put more
priority on relationships. They realize that life is short and unpredictable and they will
express more love and affection for other people. When you have suffered greatly it
sensitizes you to the suffering of people around you, not just other people who’ve lost
someone to suicide, but just that most people experience pain in their life and we’re often
not tuned into that or aware of that. But, when we have that in our own life, we can
become more sensitized to the fact that other people are experiencing that also.
People also will decide life is too short and, “I have to make up my mind about whether
I’m leading my life now the way that I want to.” They will get out of bad relationships;
bad jobs, bad friendships, bad marriages that are not helping or are dysfunctional. I see a
lot of those kinds of changes happen after a suicide.
Other forms of post-traumatic growth are a changed outlook or world view on life. Some
people say, “I have a renewed or a changed sense of purpose for my life.” It may involve
helping other people. It may involve becoming a kind of an activist about, “I’m going to
try to prevent suicide so that this doesn’t happen to other people. I’m going to reach out
to other suicide survivors.” or, it may just be, “I’m going to try to become a better person
in my own way.”
I’ve seen people who’ve felt that part of what led to the suicide was that they had
substance abuse problem and they weren’t paying enough attention to their child so they
may decide that they're going to get sober, clean and sober, and to work on that and
they're going to do it honor of their child. So, there are ways in which people decide to
become a better human being as a result of this terrible tragedy that has happened in their
life.
They also begin to feel appreciation for the things that they do have in their life and
sometimes it can deepen their spirituality or faith. Now, suicide can also produce a
spiritual crisis for people, both because of the theology of religion; if you believe your
loved one has gone to Hell as a result of the suicide that can produce a deep crisis for
some people, but just more generally like, “How could God let this happen? How could
God let this happen to me? I’ve been a good person. My child, my husband was a good
person. How could things like this happen to someone like me?” Having to work through
those issues are profound residual issues that people have to work through when they
have a traumatic experience such as a suicide. All of these are things that can lead to
psychological or spiritual growth. I don’t really care what language you use about it but
they're a form of psychological growth for individuals.
I see a question here. Let’s pause for a second and take a question before we move on. I
see a question from someone named Peggy Morse and the question is; when others say
“If that happened to my child then I just couldn’t live.” that presents a conflict to a parent
who finds resilience. Peggy, I wonder if you could explain a little bit more what your
comment means. I’m not sure if I quite understand it. I’m going to go on to the next slide
but, if you're listening, if you could just clarify a little bit about you mean or what the
question is, that would be helpful to me and I’ll try and respond to it.
So what can we do to help survivors as caregivers, as clinicians, as people who may come
in contact with survivors and want to be of help? The first thing I want to talk about are
what I see as some recovery tasks for survivors.
By recovery tasks, what I mean is the kind of psychological work that I’ve found that
people need to do to learn to carry the loss, to integrate the loss in themselves. I don’t use
the word ‘to resolve’ the loss. You sometimes hear the language used that this person has
unresolved grief. I don’t find that language very helpful because it implies that grief is
something that one, quote-unquote, resolves and gets over and then moves on with your
life. This is kind of the societal expectation and, unfortunately, it’s often the expectation
of mental health professionals too, which is that grief is something that is like an
unpleasant -- sort of like having the flu. It’s an unpleasant experience that you just sort of
get over and then move on with your life.
I’ll give you a metaphor that a member of one of my support groups once used that I
think is just spot on. It’s just perfect. He said that people think when you're grieving it’s
like having a heavy boulder put on to your shoulders and then when you get over your
grief, quote-unquote, over it, what you do is you take the boulder, you put it down on the
road, and then you just go on down the road without the boulder on your shoulders. He
said, “That isn’t what’s happening to me. What’s happening to me is that my back is
getting stronger.”
I just think that’s a perfect metaphor about what really happens, by and large, for people
who are grieving after this kind of traumatic loss. What I mean by that is that people learn
to integrate the loss and to carry it with them. They can do that more or less successfully.
I’m not saying that some people don’t have a great difficulty with that. But, this kind of
loss changes people. It has a permanent impact on people. It’s not something that people
get over and just put behind them. It becomes a part of who they are in the world. These
are tasks, then, that help people integrate the loss into who they are.
The first task really is containing the trauma and a restoration of a sense of control. This
is really true in all traumatology, is that traumatic experiences are very disregulating of
our physiology, of our emotional life, of our cognitive functioning. The first task is for
people to sort of get a handle on and contain the trauma so that it doesn’t leak into every
aspect of who you are and become a permanent way of functioning in the world.
We don’t have time in this seminar to talk about it but there are a number of techniques,
such as EMDR and things that are similar to prolonged exposure therapy that can be
useful in helping reduce trauma symptoms in suicide survivors and survivors of other
types of traumatic death.
The second task is what I call a creation of a narrative of the suicide. What I mean by that
is, because suicide is so puzzling and confusing, survivors will spend a great deal of time
trying to make sense of what has happened and they have to spend a lot of time, typically,
trying to understand the state of mind of the person who died. They have to also sort out a
sense of realistic responsibility for the death and develop a realistic perspective about the
perfect storm, really; about the multiple causes that led to this death.
Typically, survivors begin by overestimating the role that they had in the death and the
things that they could have done to have prevented it and they underestimate or just are
unaware of all the other things that may have been contributing to the suicide. Over time
people have to go think those things through and they may have to do some investigation
work.
They may need to talk to other people who had contact with the deceased, who knew
them well. If you have a child in college who takes their life, you may need to talk to that
child’s friends and roommates, their professors, to see what seemed to have been going
on with them as you try to develop a picture of what was going on psychologically with
this person.
Sometimes there is a formal procedure called a psychological autopsy that is really a
systematic way of doing this that’s used in research and sometimes in forensic medicine
by medical examiners. In essence, survivors often have to do their own personal
psychological autopsy to understand the suicide. This needs to be supported by clinicians.
Sometimes clinicians will try to short circuit this or say, “You don’t want to dwell on
this. It’s not productive to dwell on this.” But, this is a necessary task of healing for
survivors.
The third task is what I call dosing oneself. This is basically beginning to gain skill at
regulating the pain. The psychological pain can be so intense that people need to find
ways of cultivating analgesia or relief from the pain, both from traumatic images and
memories and from waves of grief that they may be experiencing.
Some of the first tasks in working with someone may be asking people, “Have you found
any way to get relief from this? Any way to distract yourself from it?” We sometimes
think, as grief counselors or as therapists, our job is to get people to go towards the pain.
But, traumatology teaches us that the first order of business for somebody who’s
traumatized is not catharsis. It is not having them be flooded with what they're already
flooded with. It is actually learning to gain a measure of control over it and then asking
people, in a controlled way, to re-expose themselves to the traumatic stimuli or triggers,
if you want to use that language.
Learn social management skills; because people around the survivor often know how to
relate to the survivor, how to provide support, because it creates a kind of social
awkwardness, survivors have to learn how to manage other people’s reactions to them.
They may have to say to people, “You know, it’s okay if I cry. It’s okay to ask me about
my son or my husband. I would like to talk about this.” Or the converse. Survivors may
need to say to other people, “You know, I mean well when you ask me questions when
you ask me what happened but I don’t understand myself yet what happened and I’d
actually rather not talk about it right now.”
So, survivors have to sometimes learn to be proactive about teaching people in their
social network what they need from the social network. Survivors often don’t know what
they need. This is a kind of trial and error learning process about being able to do this and
figuring out what is going to be helpful for me from other people.
Another skill that goes along with this is being able to stay away from or manage people
who make you feel worse. Sometimes people will say incredibly hurtful or ignorant
things to survivors. People will say, “Well, didn’t you know they were depressed? Didn’t
you see this coming?” What may be blurted out as simply wanting to get more
information but it can be incredibly hurtful to a survivor. Survivors may need to say,
“Well, no, I didn’t see it coming and that question is really a hurtful question. Please
don’t ask me questions like that again.” Or literally to avoid people who make them feel
worse. Obviously that’s difficult to do if that person is in your family or you have to
interact with them regularly. People may be able to learn how to psychologically put their
armor on or distance themselves from certain people.
There’s now beginning to be research evidence that, not only does good social support
help people heal after losses like this but, let’s call it bad social interaction -- I don’t want
to call it social support -- negative social interactions with people actually prolong
people’s grief responses.
People need to repair and transform their relationship with the deceased. I think it’s
probably a truism that we never lose anybody in our life to death without there being
some kind of unfinished business with them; things that are left unsaid, things that we
could have said or done that weren’t done. But, this can be particularly true after a suicide
in which suicide, almost by definition, tends to rupture the relationship between the
deceased and the survivor, the mourner. It comes as a revelation to people to realize that
even though the person has died, “I’m going to continue to have a kind of psychological
relationship with this person. They're going to be important to me. I’m going to carry
them in my heart and I can repair this relationship that has been so severed or that I have
been injured by.”
A skillful grief counselor can help people do that. There are lots of ways that people do it
kind of intuitively; writing letters, going to the grave, talking to the person. There are
techniques, sort of empty-chair techniques, I use guided-imagery techniques that can be
very helpful and therapeutic for people in repairing and transforming the connection with
the deceased into one that’s a more positive one and that can also involve forgiveness.
People also need to be able to develop what I would call a durable biography of the
deceased. This language is from Tony Walter, who is a British sociologist. He says the
main task of grieving is to develop what he calls a durable biography of the deceased.
This is a narrative of the life of the deceased. What happens after suicide is that it’s as if
the life story of the deceased has only one paragraph and that paragraph is the last
paragraph in the book saying, “This person died by suicide.” It’s as if that is the only
important thing about them.
One of the tasks for survivors is to able to say, “No, wait a minute. That’s not true. This
person had a life and I want to remember and honor and take pleasure in the life this
person; that suicide is not the only important or even the most important thing about this
person’s life.” It takes a while and it takes support for survivors to be able to remember
and honor the life of the person who dies, not just the death of the person who died.
Then, people have to be able to learn to live in the world without this person and to
reinvest in a new life for themselves; to rebuild their life without this person.
Let’s pause for a minute and take a look and see if there are any questions that people
have; questions or comments they want to add. This would be a good time to do it before
I move into my summary comments. Let’s go back to Peggy’s clarification. Peggy had
originally said; when others say, “If that happened to my child and I just couldn’t live.”
presents a conflict to a parent who finds resilience. Then she goes on to clarify; survivor
guilt. The death is life-changing but you still find a way to carry the loss and function. It
doesn’t mean that you loved them less.
I think, perhaps, what Peggy is saying is that, sometimes when people lose someone to
suicide, they do find that, in addition to the pain and the sorrow, there can also be positive
changes that happen inside themselves. They can feel guilty about finding the positive
changes inside themselves. That can be a problem.
Part of why I mention relief when I do a presentation about suicide bereavement is
because I want people to understand that relief can be a normal emotion and part of why I
talk about post-traumatic growth is because I want people to understand that the human
spirit has enormous resilience in it and that people do grow after these kinds of
experiences. They don’t grow because of this, and I’ve never met a survivor who said,
“This is the best thing that ever happened to me in my life.” but what you hear is that
people say, “I grew in spite of this. I would give anything to have this person back but,
given that it happened, I found a way to carry this boulder.” if you will, to go back to that
metaphor, “and I became a stronger or wiser or better person as a result of this.”
Sometimes people can feel conflicted about this, that, “I had to lose my loved one this
way for this to happen.”
If there are other questions or comments that people have, please feel free to add them.
I’m going to go on to talk about my concluding comments now.
These are the kind of summary comments that I would like to make about grief after
suicide and about working with someone who is bereaved by suicide. The first thing is
that, as a caregiver, as a clinician I want you to revise and be open to revising your
assumptions about the grieving process and about what role you play as a caregiver or
clinician with survivors.
First of all you have to be open to revising your assumptions about how long the grieving
process takes and the intensity of the grief. I’ve already shared the metaphor about the
people learn to carry the boulder, not set it down and leave it behind them. In a very real
sense, people will grieve for the rest of their life. So, the goal of grief is not to get over
their grief, it’s to learn to carry it better and to integrate it for the individual.
That doesn’t mean that people don’t feel better over time. They do. It doesn’t mean that
some of the symptoms of grief; trouble sleeping, trouble concentrating, being able to
function in one’s roles as a parent, at work, as a marital partner, etc. I’m not saying that
that functioning doesn’t return. It does. If doesn’t return, given a reasonable amount of
time, that’s problematic.
But, we do know, from a growing amount of research, that the time trajectory after
traumatic losses, not just suicide but after homicides, after sudden unexpected violent
death of a loved one, typically is much longer than after more normative deaths.
Intuitively that makes sense. If your great-grandmother dies, at age 97, peacefully in her
sleep, it’s probably not going to take you years to get over that, unless she played a very
important role in your life and was central to your functioning. If your child is murdered
or if your child kills themself, it’s going to take you a very long time, much longer period
of time, for you to heal or to recover from that. The intensity of the grief is not going to
be the same as losing your great-grandparent.
The goal is integration, not resolution. I’ve already commented on that. The role of the
clinician is really not of treatment, the way we think of treating medical conditions or
problems.
I don’t have time to go into this in depth but the psychotherapy that Kassin feels has
really been dominated by a medical model. It suggests that what we do is similar to what
doctors do when they treat sore throats or when they treat cancer, in which we diagnose
people and then we apply treatments to people and the patient’s job is to be a cooperative
patient. It’s a very hierarchical model.
In the grief counseling field, people are arguing that what we need to think of this as
doing is -- they’ve invented a new verb called companioning -- that what we are doing
actually is walking with people at a very difficult time in their life and we’re really
serving as a kind of attachment figure for people in a very difficult time in their life, in a
sense, as kind of equals rather than as being an expert that knows better for people what
they need than they know for themselves.
Second, the goal of counseling in grief support if to provide a safe and sheltered context
in which people can do their grief work and can learn new coping skills. Grieving is a
process of skill acquisition. That’s not usually how we think of it but people learn new
skills about managing their own reactions, about managing the reactions of other people,
about reforming their identity. These are all skills that people have to learn to cope and to
integrate the loss into their life. The good news is that skills can be learned and can be
taught to people.
It’s important to attend to traumatization. I think grief counselors or people focused on
grief sometimes really focus on the sorrow and the sadness aspects and underestimate
how important the trauma aspects are. It is difficult to work on grief and loss when
people are having flashbacks, when they are re-living horrific experiences which tend to
interfere with being able to mourn. I really think a combined approach, using techniques
and interventions from traumatology and from thanatology, the grief counseling field, is
really what’s best when we’re thinking about working with suicide survivors.
It’s important to support the construction of a narrative and support the survivor in the
developing and understanding. People need to educate themselves about suicide, about
grief, about psychiatric disorder as background information as they try to understand,
“Why did this person take their life at this point in their life?” Background information,
but understanding about what contributes to suicide, what is grief after suicide like, what
is psychiatric disorder. These are all things that many people maybe have very little
familiarity with until they encounter the suicide of someone important to them. You can
really help facilitate that when you help people educate themselves about these matters.
You want to help people learn to dose themselves; first of all, just giving people
permission to do that. It is okay to learn skills of distracting yourself from the pain. I
basically will say to people, “Whatever you do that gives yourself some relief from this,
as long as it is not self-destructive and not destructive of your relationship with other
people, it’s okay to do it and you should cultivate it.” So that obviously getting
intoxicated every night on alcohol is not a good idea but if going to the movies and losing
yourself in a funny movie is helpful for you, then go ahead and do that.
Sometimes families will sort of cancel holidays the first year and they will go -- if they’re
Christian and they're coming up to Christmas, they may say, “We’re not going to do
Christmas this year. We’re going to the Bahamas, someplace where it’s warm and sunny
and there’s no snow and there’s no cold weather and there’s -- well there’s Santa Clauses
everywhere in the world now but where there’s not so many reminders because it will be
easier for us if we’re not confronted with all of this holiday reminder stuff.” That’s fine.
What you should do is caution people that when you come back you’re going to be hit
with it again so it will be difficult coming back. But, that’s fine and usually people will
tell you, “You know, it was a little easier for us because we gave ourselves permission to
put this all at arms-length for a while.” Validate any form of analgesia that is not
destructive.
Address family and social network issues, particularly scapegoating as I mentioned
before. This will be a good 40% to 50% of what people will talk to you about is the
problems they are having dealing with other people in their social network; either their
family or in their friendship network in which other people are having trouble
understanding, people are saying unhelpful things, or people are avoiding them. Coaching
them, brainstorming with them about how to deal with those things can be very valuable
because this will be a whole new set of problems that people never dreamed of that they
would have after they’ve lost someone to suicide.
Facilitate contact with other survivors. There’s a growing amount of evidence that, not
for everybody but for many people, being able to have contact with other people who are
going through the same experience can be very therapeutic. There are a lot of ways to do
that. Face-to-face survivor groups can help. Online survivor groups can help. Reading the
narratives of other people who’ve lost someone to suicide is a way of having an empathic
experience with other people who’ve lost someone to suicide.
In the Boston area, the Samaritans of Boston runs the Grief Support Services, which is an
excellent resource for people who are grieving after a suicide. Nationally, both the
American Foundation for Suicide Prevention and the American Association of
Suicidology have online databases of survivors support groups around the country.
Also the Samaritans in Boston has what we call our Survivor-to-Survivor Network which
are trained volunteer survivors who go out and meet with new survivor families in their
home so that the survivor doesn’t have to some to a drop-in support group. The members
of the Survivor-to-Survivor Network will come and visit with the new family. All of
these resources are on your reading list, the organizations that I just mentioned.
Go slowly with guilt. This is something that I think is very important. An instinct we
have when we see someone suffering a great deal with a lot of guilt and blaming
themselves is we want to take it away. We want to make them not be in so much pain. I
understand that. That’s a very compassionate instinct but you can’t do it for people.
People have to work through their guilt and, in essence, put their guilt in perspective
themselves rather than you simply absolving them from the guilt. I sometimes will say to
survivors, “Look, you’ve probably going to have to put yourself on trial. I understand
that. I even will support that. My goal is that you and I try and have a fair trial and that
we look at all the evidence here rather than having a kind of kangaroo court in which you
immediately convict yourself here.”
Lastly, follow the principle of don’t waste your grief. This is something I heard Terry
Maltsberger, who is a psychiatrist who’s worked most of his professional life around
suicide prevention, saying that he was talking to a group of survivors and a woman who
had lost a child to suicide got up and said, “Dr. Maltsberger, I don’t know what to do
with myself. What am I supposed to do now with my grief?” Terry said, without a
moment’s hesitation. “Well, don’t waste your grief.” What he has really saying is, “Try to
find some way of making something redemptive or good come out of this.”
I’ve found that to be an enormously useful principle in working with survivors,
particularly for people who have an enormous amount of guilt and are unable to absolve
themselves or to work that through. Then, perhaps what they need to do is to find a way
to, in a sense, atone for that by becoming a better person or being a service to other
people in some way but make something redemptive or good come out of this.
There’s now actually some research evidence that people who are able to this, to find
meaning and to find some constructive purposeful meaning and activity that comes out of
their grief do better than people who simply sit with the pain and the misery that they're
experiencing.
I think there are a couple of other questions. Let me try to attend to those and then we’ll
wrap up. Let me read the questions.
From Cheryl Poisey (ph), forgive me if I mispronounced that; secondary traumatization
issues, for example father of a son who completed suicide wondered if he in his role as a
police officer responded in his past with adequate empathy to other families who had
experienced suicide. How to help deal with this?
That goes to the guilt issues. What he is doing is he’s had a kind of awakening of his
consciousness. He now understands what it feels like to lose someone to suicide and I
would help him examine that. I wouldn’t rush to say, “Oh, I’m sure you’ve been fine.” I
wouldn’t try to cut that off prematurely but help do an honest and realistic -- he may be
accusing himself too much so you want to try to help him realistically look at how he’s
done in the past and, more importantly, how he can do it better going forward. This is a
perfect example of what I was just talking about, about not wasting his grief but
becoming a better person as a result of it.
Suzanne Norton comments; I find it very unfortunate that often times the gatekeeper to
people’s suicide-related emotional grief is the doctor whose immediate reaction is to
medicate and then refer to a counselor or therapist. How can providers allow patients to
be more involved treatment and care of what they're dealing with versus creating
cocktails of relief?
I hear what you’re saying, Suzanne. I think this is an unfortunate growing trend which is
to immediately medicate. We all want to do something right away to help relieve the pain
and doctors are human beings so when a patient is sitting in front of them and saying,
“My son has just killed himself.” And the doctor doesn’t know what to do and is feeling
helpless they say, “Well, okay, I can write a script for you.” Sometimes they just write a
script and that’s all they do. At least if a doctor is saying “Let me write a script for you
and I want to refer you to a counselor.” I think that’s preferable to simply writing a script.
What I would rather see happen -- I don’t object to the use of psychotropic medication. I
think it can have a very useful role in grief counseling but it needs to be part of an overall
plan about how to help the person that has to involve human contact not simply a
medication. Unless the person is refusing to see a counselor they just say “I want a pill”
that may a different story. Most people are sort of grasping at straws, in that they will try
whatever is recommended to them, and I don’t think medication is sufficient in those
cases. That’s my belief or bias about this. I hear you. How to change that is we have to
educate physicians and medical professionals about dealing with, not just with suicide,
but with traumatic grief.
From Barbara Nealon; at our facility we had a patient-family peer suicide. We enhanced
our QPR training -- which is a training for recognizing and knowing how to respond
when someone is suicidal, QPR training. We enhanced our QPR for the staff and
community. We developed our own in-house team to provide support using the CISM
principles. We had a tough year and found ourselves needing to debrief, diffuse, through
being so entrenched ourselves with our grief. Positive outcome; we built a stronger
relationship with one another and developed the survivor support group. We just
recognized our one year of this group and it is meeting a huge need in our community.
Hallelujah. It sounds like your organization responded very well to this, Barbara. You
made a very constructive and adaptive response. It sounds like your organization did not
waste your grief. That sounds very good.
Let’s do a last question here from Melanie Varady; AFSP Boston chapter also has a
survivor outreach program.
Yes. I didn’t mention that. AFSP also has a survivor outreach program in which trained
survivor volunteers will come and meet with new survivors. If you contact the local
AFSP chapter, and you can get their number by going to the national website and get the
local AFSP New England chapter, they have a survivor outreach team as well. I guess
Melanie is the Chapter Director for the AFSP Boston chapter.
Cheryl says thank you. I would like to thank each of you for joining us for this webinar
today. I really appreciate the work that you're doing and the one thing ask people at the
end of any training that I do is that you take whatever you feel you’ve gotten from this
seminar and pay it forward to someone else. Thanks very much for joining us today.
Brandy Brooks: Just before we break here, I’d just like to piggyback off of Dr. Jordan’s
thanks for everyone participating. I’d also like to thank Dr. Jordan for participating and
presenting this webinar.
I don’t know if it was mentioned earlier but I will be emailing slides, as well as a link to
the podcast for this webinar, and a survey that I’d like all participants to complete, if you
would be so kind. In addition, be on the lookout for any emails about upcoming webinars
and trainings being sponsored by the Department of Public Health.
I hope today you’ve gained more knowledge about the common themes in bereavement
after suicide, some of the psychological recovery tasks for survivors and, as well, some
broad clinical guidelines for working with survivors of suicide.
Again, thank you all for participating. Have a wonderful day. Dr. Jordan, I don’t know if
you have any concluding comments you’d like to share.
Jack Jordan: Just to thank people.
Brandy Brooks: Okay. Alright, well thank you all for participating. Have a great day.