The Painful But Important Lessons I Learned After My Father’s Suicide

By Christiana Zenner, Ph.D.

Anthony Bourdain; Kate Spade; friends, teenagers, neighbors, veterans; my father. Every suicide is distinct and differently devastating, for those who leave and for those who are left.

Yet there are some commonalities, some moments of recognition both in terms of frequent contributing causes and also in terms of what comes next. Here are the hard and important lessons I’ve learned since my father took his life in 2007—when he was 60, and I was pregnant and in graduate school:

1. Suicide is terrifying.

Suicide is what philosophers and mathematicians refer to as a surd—nonsensical, unexpected, a cavernous impossibility that is nonetheless real.

How often do we presume that other people’s lives are on positive trajectories, if not always totally predictable ones?

Perhaps life looked fine, even good, on the outside (as was the case with Bourdain). Or perhaps friends and family members knew the person was struggling but had sought help, and they seemed to be OK (Spade).

After a suicide, many people will say it “doesn’t make sense.” In many cases, yes, there’s a stunned inability to process that the person is gone. But I think there’s a deeper fear at work here, too: the terror of realizing, “Oh my god, if it could happen to them—could this happen to anyone, even people I love, even me?

It is OK to admit that fear and the cascade of uncertainty it unleashes. Suicide uproots our background assumptions that life makes sense.

2. There are no answers.

There may be generally explicable features in many suicides, but there are no ultimate answers. Hold space for the uncertainty, for the dimensionality of who this person was.

My father was a Navy fighter pilot before he left the military to become a commercial airline pilot. Like many vets, his experiences in Vietnam were traumatizing; he talked about them only rarely, but when he did, the moral and personal agony was palpable. Did he have PTSD? Probably, and society needs to do a better job of destigmatizing veterans and people who have been through trauma. But PTSD isn’t the full story.

The most common response people have when I say that my father killed himself is, “Oh, that’s terrible. Was he depressed?” We don’t know. As a pilot, he resisted seeking psychological diagnoses that would prevent him from flying.

Perhaps he was bipolar, as many family members now think likely. It’s natural to wonder, but we will never know for sure. Posthumous speculation can clarify past patterns. Diagnoses of depression are attractive to people who want explanations. But again: Be careful with the urge to make this “make sense”—because often, that is another way to say, “Oh, this would never happen to me or someone I know.” One of the things that suicide challenges us to do is to recognize that other people’s realities and dimensions far exceed the capacity of our projection.

3. Humility goes a long way.

Check yourself: Avoid explaining what this death means to someone who is grieving a suicide. (This is especially important if you think you have insights or are convinced you are being helpful.) Be present. People in grief need to lean on you, not be lectured by you. And what is true in grief more generally is excruciatingly so when mourning a person who has died by suicide. Frankly, unless we have explicitly said, “What do you think?” it is not at all helpful to hear your speculations or interpretations of what this event means. What we need is the space to grieve and heal in our own complicated realities.

More generally, all of us can work to eliminate unnecessary sayings that are obvious triggers—like “the line at the grocery store was so awful, I just wanted to kill myself!” or making hand gestures that mimic firing a gun into your mouth. It’s been 11 years since my father’s death, and I still cringe at those expressions. Communication evolves with social consciousness, so it’s time to retire those basic expressions.

4. Suicide, I believe, stems from hopelessness—not selfishness.

Some people feel that suicide is a selfish act because it fails to account for the difficulty and devastation wrought on the people who remain. But I agree with the many experts who suggest that suicide is often the result of a total loss of hope and self amid a tsunami of despair.

Suicide may feel selfish to survivors—how could he?—but when someone dies by suicide, they do it not out of selfishness or spite. They do it out of ultimate loneliness and pain so deep that most of us cannot begin to comprehend it because it is on a totally different plane of existence.

5. High-functioning people don’t give many signals. When they do, take those seriously.

My father expressed to a few people that he was thinking of ending his life. Those people, who I know loved him deeply, took him at his word that he would seek help. But I know now that such statements are the high-functioning person’s attempt to seek help—it takes massive effort and will to reach across a divide of loneliness and despair, to entrust someone with such honesty about such heavy burdens. It is another way of saying, “I am alone. I don’t know how to proceed; please help me.”

Take these statements seriously. Accompany the person to get help, right then if possible.

Our society can be very isolating. One antidote that we can give to one another as human beings in moments large and small is in our ability to see one another—to affirm the uniqueness and worth of each individual. We can contribute to bonds and societies that feel secure, safe, trustworthy, and consistent—and perhaps make life a bit less lonely, not just when someone confides in us, but in the caliber and kindness of our everyday interactions.

6. For survivors, some grief is incommunicable.

It is not your job to make your grief legible or to make it conform to other people’s expectations. As a survivor, you will have major triggers that are unrecognizable to most people, and your reactions will vary. I can be totally leveled by the image of my dad’s back in his blue blazer as he strode tiredly away from me at my sister’s graduation, or by how I imagined him leaving the house for the last time, or the first 100-plus times I drove by the fire station outside of which he shot himself. Even the feeling of exhilaration on white water, a delight that he and I shared—these are all particularly potent emotional, geographic, and physical triggers for me, even 11 years later. Most people have no idea.

If you are a survivor, let the emotions surface, and let them pass (not easy: It’s like getting thrashed by a huge wave of rage, sadness, and ugly crying). Let me repeat: You don’t have to hide your emotions, and you don’t have to apologize for them. You don’t even have to explain them. Grief is a shape-shifting, surprising, and (in the case of suicide) often terrifying entity. Lean into people who are trustworthy, nonjudgmental, and who let you be you. And when you meet people who have also experienced the suicide of a loved one or family member, you might find yourself weeping together on top of a mountain during spring ski season (true story). It’s OK.

Presence, care, laughter, and gentleness are salves. I have personally found therapy to be fantastically helpful, and many people benefit from survivor support groups. If you are trying to support someone who is grieving the loss of a friend or family member through suicide, support them with presence and infrastructure. Just hug. Sit. Bring food. Come over to walk the dog together. Call to say you’re thinking of them.

7. Your presence will sometimes make people uncomfortable. Many will react strangely.

People say weird and even hurtful things out of their own profound discomfort after a suicide. Others will disappear entirely from your life. This sucks, but it’s true. Suicide (along with what I call the 3Ds—other forms of sudden death, divorce, and disability) can make people really nervous, and as a result they may react to your presence in all kinds of intense and often unhelpful ways.

One person with whom I was close didn’t call, text, or write me for nearly a year after. Only when I ran into her at a party by chance later did she laugh awkwardly and say, “Yeah, sorry about that. I mean, what could I even have said?” My answer now: “Just call and say you don’t know what to say, and you love me and are thinking of me.”

I have learned that people’s reactions and statements say much more about what they are grappling with than what is true for you. This doesn’t make it easier in the moment, but it does mean you don’t have to take on their stuff. Find your way with the people who let you be you, without foisting their own anxious interpretations onto you.

8. Memorialize in ways that feel right to you.

Just as everyone grieves differently, everyone memorializes differently. In the aftermath of a suicide, ritual and burial are important, though they can take many forms. For some people, traditional religious funeral services may provide important closure. For others, those same services might feel like emotional handcuffs.

As time goes on, trust your creativity and the legacy of the person’s memory. What are the moments that make you think of them with a grin? Consider memorializing a place or an activity that feels like a positive legacy—a meditation bench in a treasured spot or an annual walk with organizations that raise awareness about suicide or mental illness, for example. I have found it meaningful to memorialize my father by consciously giving him a shout out during water sports that we both loved.

Finally: The days around the anniversary of the suicide will be tough. Be gentle with yourself in these times. You also deserve love and kindness.

9. You will change, and your relationships will too.

Suicide is an extreme event that, for survivors, puts much into excruciating texture. For me, my father’s death began a decade-long journey of self-reflection—about myself, my family, my partnership, me as a parent, and society more generally. It has involved devastating anxiety that, with time and therapy and life changes, has given way to profound, gentle, exhilarating clarities. Many relationships, including my marriage, were sundered as a result of this journey.

It has not been easy. Grief doesn’t end, but it does change, and with time it becomes less debilitating, more gently poignant. I wish beyond words that my daughter could have met her grandfather. I also have found ways that my father’s positive legacy lives on in me—and in her.

One aspect of my journey is a radical honesty, forged in agonies that none of us wished on ourselves. I am the person that I am because of many factors. One of them is my father’s suicide.

10. You can be OK.

There are no neat closures to the surd of suicide. But healing can be real. Small or large changes in your life may emerge over time. Sometimes they will surprise you. But I’m here to tell you: There is healing, and believe me—you are not alone. With the life you have, you can narrate the story that you are always unfurling.

If you’re feeling suicidal or know anyone who is, the National Suicide Prevention Lifeline in the U.S. is at 1-800-273-8255.

Complete Article HERE!

Suicide survivors face grief, questions, challenges

By

The recent, untimely deaths of Kate Spade, reportedly from depression-related suicide, and of Anthony Bourdain, also from apparent suicide, came as a surprise to many. How could a fashion designer and businesswoman known for her whimsical creations and a chef, author and television personality who embodied a lust for life be depressed enough to end their lives? Crushing sadness can hide behind many facades.

According to a report by the US Centers for Disease Control and Prevention (CDC), suicide rates for adults in the United States are on the rise; since 1999, suicide rates in 25 states increased by more than 30%. In the US, suicide accounted for nearly 45,000 deaths in 2016.

Each person who dies by suicide leaves behind an estimated six or more “suicide survivors” — people who’ve lost someone they care about deeply and are left grieving and struggling to understand.

The grief process is always difficult. But a loss through suicide is like no other, and grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. Why? Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help.

What makes suicide different

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging. For example:

A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While still in shock, they may be asked if they want to visit the death scene. Sometimes officials discourage the visit as too upsetting; other times they encourage it. “Either may be the right decision for an individual. But it can add to the trauma if people feel that they don’t have a choice,” says Jack Jordan, Ph.D., clinical psychologist in Wellesley, MA and co-author of After Suicide Loss: Coping with Your Grief.

Recurring thoughts. A suicide survivor may have recurring thoughts of the death and its circumstances, replaying over and over the loved one’s final moments or their last encounter in an effort to understand — or simply because the thoughts won’t stop coming. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

Stigma, shame, and isolation. There’s a powerful stigma attached to mental illness (a factor in most suicides). Many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family’s ability to provide mutual support.

Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on, or rejection of, those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.

Need for reason. “What if” questions can arise after any death. What if we’d gone to a doctor sooner? What if we hadn’t let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to successfully intervene. In such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.

“Suicide can shatter the things you take for granted about yourself, your relationships, and your world,” says Dr. Jordan. Some survivors conduct a psychological “autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide. This can help develop a narrative that makes sense.

Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. “It doesn’t mean someone didn’t love their life,” says Holly Prigerson, Ph.D., professor of psychiatry at Harvard Medical School and Director of Psycho-Oncology Research, Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute.

Support from other survivors

Suicide survivors often find individual counseling (see “Getting professional help”) and suicide support groups to be particularly helpful. There are many general grief support groups, but those focused on suicide appear to be much more valuable.

“Some people also find it helpful to be in a group with a similar kinship relationship, so parents are talking to other parents. On the other hand, it can be helpful for parents to be in a group where they hear from people who have lost a sibling — they may learn more about what it’s like for their other children,” says Dr. Jordan.

Some support groups are facilitated by mental health professionals; others by laypersons. “If you go and feel comfortable and safe — [feel] that you can open up and won’t be judged — that’s more important than whether the group is led by a professional or a layperson,” says Dr. Prigerson. Lay leaders of support groups are often themselves suicide survivors; many are trained by the American Foundation for Suicide Prevention.

For those who don’t have access to a group or feel uncomfortable meeting in person, Internet support groups are a growing resource. In a study comparing parents who made use of the Internet and those who used in-person groups, the Web users liked the unlimited time and 24-hour availability of Internet support. Survivors who were depressed or felt stigmatized by the suicide were more likely to gain help from Internet support services.

You can join a support group at any time: soon after the death, when you feel ready to be social, or even long after the suicide if you feel you could use support, perhaps around a holiday or an anniversary of the death.

Getting professional help

Suicide survivors are more likely than other bereaved people to seek the help of a mental health professional. Look for a skilled therapist who is experienced in working with grief after suicide. The therapist can support you in many ways, including these:

  • helping you make sense of the death and better understand any psychiatric problems the deceased may have had
  • treating you, if you’re experiencing PTSD
  • exploring unfinished issues in your relationship with the deceased
  • aiding you in coping with divergent reactions among family members
  • offering support and understanding as you go through your unique grieving process.

A friend in need

Knowing what to say or how to help someone after a death is always difficult, but don’t let fear of saying or doing the wrong thing keep you from reaching out to a suicide survivor. Just as you might after any other death, express your concern, pitch in with practical tasks, and listen to whatever the person wants to tell you. Here are some special considerations:

Stay close. Families often feel stigmatized and cut off after a suicide. If you avoid contact because you don’t know what to say or do, family members may feel blamed and isolated. Ignore your doubts and make contact. Survivors learn to forgive awkward behaviors or clumsy statements, as long as your support and compassion are evident.

Avoid hollow reassurance. It’s not comforting to hear well-meant assurances that “things will get better” or “at least he’s no longer suffering.” Instead, the bereaved may feel that you don’t want to acknowledge or hear them express their pain and grief.

Don’t ask for an explanation. Survivors often feel as though they’re being grilled: Was there a note? Did you suspect anything? The survivor may be searching for answers, but your role for the foreseeable future is simply to be supportive and listen to what they have to say about the person, the death, and their feelings.

Remember his or her life. Suicide isn’t the most important thing about the person who died. Share memories and stories; use the person’s name (“Remember when Brian taught my daughter how to ride a two-wheeler?”). If suicide has come at the end of a long struggle with mental or physical illness, be aware that the family may want to recognize the ongoing illness as the true cause of death.

Acknowledge uncertainty. Survivors are not all alike. Even if you are a suicide survivor yourself, don’t assume that another person’s feelings and needs will be the same as yours. It’s fine to say you can’t imagine what this is like or how to help. Follow the survivor’s lead when broaching sensitive topics: “Would you like to talk about what happened?” (Ask only if you’re willing to listen to the details.) Even a survivor who doesn’t want to talk will appreciate that you asked.

Help with the practical things. Offer to run errands, provide rides to appointments, or watch over children. Ask if you can help with chores such as watering the garden, walking the dog, or putting away groceries. The survivor may want you to sit quietly, or perhaps pray, with him or her. Ask directly, “What can I do to help?”

Be there for the long haul. Dr. Jordan calls our culture’s standard approach to grief the “flu model”: grief is unpleasant but is relatively short-lived. After a stay at home, the bereaved person will jump back into life. Unfortunately, that means that once survivors are back at work and able to smile or socialize again, they quickly get the message that they shouldn’t talk about their continuing grief. Even if a survivor isn’t bringing up the subject, you can ask how she or he is coping with the death and be ready to listen (or respect a wish not to talk about it). Be patient and willing to hear the same stories or concerns repeatedly. Acknowledging emotional days such as a birthday or anniversary of the death — by calling or sending a card, for example — demonstrates your support and ongoing appreciation of the loss.

Helpful resources for suicide survivors are available at from the American Foundation for Suicide Prevention and the American Association of Suicidology.

Complete Article HERE!

6 Ways to Help Someone Who Lost a Loved One to Suicide

Family members and close friends of someone who dies by suicide are at increased risk of suicide themselves. Here’s how you can help.

By Sarah Klein

There’s a common estimate that every suicide leaves behind six survivors who are the most affected by the death. Not to be confused with suicide attempt survivors, who have taken action toward ending their own lives, suicide survivors or suicide loss survivors are friends or family members of someone who died by suicide.

Suicide loss survivors are themselves at an increased risk of mental health conditions and suicide in the future. One study found that people who knew someone who died by suicide in the previous year were 1.6 times more likely to have suicidal thoughts, 2.9 times more likely to make a suicide plan, and 3.7 times more likely to make a suicide attempt than people who did not know someone who died by suicide.

Family members may be genetically predisposed to suicide, while friends and peers may be influenced by the behavior of a person who died by suicide—or distraught by the “emotional destruction suicide leaves in its wake,” says John R. Jordan, PhD, a clinical psychologist in Pawtucket, Rhode Island, and the author of several books and articles on bereavement after suicide.

To address this increased risk, experts in the field of suicide practice something called suicide postvention. “[Clinical psychologist] Edwin Shneidman coined the term to mean what we do after a suicide has happened to help people who are loss survivors and help reduce their risk of suicide,” Jordan says.

Postvention tactics can include professional measures, like therapy sessions or meetings with a support group. But help can also come from family and friends. If you know someone who is a recent survivor of suicide loss, here are expert-recommended ways you can help.

Be present

“Even though this is changing, suicide is still a very stigmatized death,” Jordan says. “Losing someone to suicide can be tremendously isolating. Many people either don’t know anybody or don’t know they know somebody” who was close to someone who died by suicide, he says. Help break down those isolating walls by being there for your friend or family member

Kim Ruocco’s husband died by suicide in 2005. A Marine Corps pilot, he came back from what she describes as a “pretty difficult deployment” in Iraq with PTSD, depression, and anxiety. Their sons were 8 and 10 at the time.

Ruocco, who has a master’s degree in social work and is now the vice president of suicide postvention and prevention at the Tragedy Assistant Program for Survivors, says she took comfort in people simply being by her side. “The people who were most helpful to me could be in my presence and tolerate my pain and didn’t have to say anything,” she says. “There are no right words really, but it was really comforting to have someone who can be with you with that much pain.”

Deflect feelings of blame

Grief is never easy, but grief in the wake of suicide can be particularly complicated, says Mara Pheister, MD, an associate professor in psychiatry and behavioral medicine at the Medical College of Wisconsin, who has researched suicide prevention and postvention. “There’s the sense that it is a little different than the grief involved in losing someone in general. There can be a lot of guilt, a lot of what if,” she says.

Because a suicide loss survivor may already be blaming themselves for not doing something differently, comments like, “How could you not have known?” or “Why didn’t you stop him?” are particularly unhelpful, Dr. Pheister says. “That’s not something that needs to be said.”

Other survivors may be working through feelings of blame surrounding what turned out to be their final interaction or conversation with the person who died, Ruocco adds. “Help them understand that suicide is a multi-factor event that comes together on a kind of ‘perfect storm’ day,” she says, and encourage them to try to let go of that kind of guilt.

Let them dictate how much detail to share

Although it can be uncomfortable and scary to talk about suicide, avoiding the topic altogether might make a suicide survivor feel like you’re pretending nothing happened. Don’t shy away from talking about suicide—but don’t pry for details, either. Listen to how the survivor is talking about it and take cues from them. “Be there for them if they want to talk about it,” Dr. Pheister says. “It depends on what the person feels like bringing up themselves, what they’re okay talking about.”

That includes how you talk about the person’s death, Ruocco says. “Everyone is different in what kinds of words they want to use in connection with their loved one’s death,” she says. “Listen carefully to how the survivors are talking about the death and use those words.”

When in doubt, ask for guidance. Say something like: “I can only try to imagine what this is like for you. Would it be helpful for you to talk to me, or would you rather not talk about it?” Jordan says. However they respond, treat the person with compassion, as you would anyone who is grieving the death of a loved one, he says.

Celebrate the life the person lived

Put aside your curiosity about how the person died and instead share stories of how they lived. Funny stories of her husband or memories she may not have heard before were most comforting, Ruocco says.

“Use their loved one’s name, remember who they were before they struggled with whatever their issues were, acknowledge that the death doesn’t define them,” Ruocco says. “Talking about the life they lived is incredibly helpful.”

Reassure the survivor their feelings are normal

Alongside the guilt that a survivor might be feeling, there could also be sadness, self-doubt, anger, helplessness, and a wide range of other totally normal reactions, Dr. Pheister says. “Depending on how much the person [who died by suicide] was struggling, the survivor might [also] feel relief, which then induces more guilt,” she says. You can help by reinforcing that these and many other emotions are all well within the range of normal reactions to suicide loss. For example, help them “recognize that relief is the natural response to the removal of stress,” Dr. Pheister says.

Talking about how a person is feeling—and that it’s okay to feel that way—might help stave off some self-judgment and self-doubt, Dr. Pheister says.

Help them embrace their grief

Survivors often expect to grieve for a set period of time and then get over it, Ruocco says, which isn’t always the case. “Grief and loss become a part of who you are; people grieve their entire lives,” she says.

With time, grief can certainly become less painful—but it may still linger, she says. She counsels survivors to think of it in a somewhat more positive light. “Grief is love. You grieve because you loved someone. See it as a connection with a loved one.”

If you or someone you know is thinking about suicide, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Complete Article HERE!

Suicide over time and across different cultures

By Dr. Phil Kronk

Is suicide a human characteristic that can never be erased?

Is there more than one kind of suicide…and more than one way to view suicide?

Has suicide been viewed by other cultures in ways different from our society today?

Tamil Nadu, in the southern region of India, has had the highest number of suicides for decades. Over 135,000 individuals killed themselves in a recent year.

The ancient Vikings hoped to someday be admitted to their paradise called Valhalla. Only violent death in battle or suicide could bring you to the heavenly halls of Valhalla. All else were denied entrance.

A form of assisted suicide, which caused death by abandonment, is called senicide. Prior to 1939 and only under extreme conditions, such as famine, the Inuit’s, an Eskimo tribe in Northern Alaska, placed their weak, sick elderly on the ice to die…to save the dwindling resources of the tribe.

We know that the Mayan citizens willingly went to be sacrificed to their gods. Ixtab, a Mayan goddess worshiped in the Yucatan region of Mexico, was followed by those who hanged themselves. To this day, that section of Mexico has the highest rate of suicide by hanging.

We find altruistic suicide throughout history in real life and in literature.

During the second world war, as the troop ship, the Dorchester, was sinking, four chaplains gave up their own life jackets, held hands, singing God’s praise and drowned together. The four included a Roman Catholic priest, a rabbi, a Methodist minister and a Reformed Church in America minister.

In literature, suicide is the solution for love denied in Romeo and Juliet.

Sydney Carton, in Dicken’s novel, A Tale of Two Cities, goes to his death on the guillotine in order to save the life of another. His last thoughts view his sacrificial suicide as “…a far, far better thing I do than I have ever done.”

Schopenhauer wrote of suicide as a question that “man puts to nature, trying to force her to answer.”

Other forms of suicide are sanctioned today.

Some European countries and some states in the U.S. allow “physician-assisted suicide” for those seeking relief from terminal physical illness.

Perhaps, the best book I have ever read on suicide is The Savage God (1970) by Alfred Alvarez, who admits to and describes his own “failed suicide.” Alvarez writes that “…suicide means different things to different people at different times.”

For the longest time in Europe and America, the act of suicide was punished, if it was not completed. Alverez notes that “the savagery of any punishment is proportional to the fear of the act.” And the person who survived his or her suicide was harshly punished. The Catholic church also refused burial in sacred ground for any suicide.

Dante’s 7th circle of hell is “The Wood of the Suicides,” where horrible punishment is meted out for eternity.

For a long time in our society, suicide, much like divorce, was viewed as a failure.

Today, we see suicide as an act of mental illness, a “cry for help” and a result of severe depression. Alverez called suicide due to depression “…a kind of spiritual winter, frozen, sterile, unmoving.”

Some feel that we must guard against turning suicide into a sanitized, emotionally isolated scientific form of epidemiology and record-keeping. There is always this danger when society ‘pathologizes’ a complex human act.

A noted psychoanalyst recently wrote to me about this series on suicide. He noted that it was easy to only think of suicide “as an illness to be cured or prevented.” “Dying, like being born” he wrote, “is an inescapably individual experience. They differ because one cannot choose to be born. Choosing to live in pain or in the face of meaninglessness is an act of will.” He saw choosing not to live as no less an act of will, and “what is important is whether one chooses or is driven.”

We must never forget the suffering that comes before a person attempts suicide. Alvarez notes that at night the depressed person lies down in terror, only to wake up in the morning in despair.

We must continue to hear the voices of those suffering, no matter how faint the cry for help or how disguised the motive…before the final solution of suicide is attempted.

The National Suicide Prevention Lifeline is (1-800-273-8255.)

Complete Article HERE!

How To Talk About Suicide Safely

The way we discuss suicide can unintentionally cause harm, but it doesn’t have to

By Leah Fessler

[M]any people are discussing and grieving fashion designer Kate Spade’s death, apparently by suicide. And in these moments, it becomes essential to discussing suicide as safely as possible.

Whether you knew the person who lost their life personally or as a public figure, whether you’re speaking in private, public, or as a member of the press, the way you discuss suicide can affect those around you. By following a few guidelines outlined by suicide prevention specialists and public health practitioners, you can minimize some risks.

What is suicide contagion?

According to the US Centers for Disease Control, suicide rates among adolescents and young adults have increased sharply in recent decades. Suicide is now the second-leading cause of death among young people 10 to 24, and lesbian, gay, and bi-sexual youth are almost five times as likely to have attempted suicide. In a national survey by the National Center for Transgender Equality, 40% of transgender adults reported having made a suicide attempt in their lifetime and 92% of these individuals reported having attempted suicide before the age of 25.

Adolescents and young adults who die by suicide are less likely to be clinically depressed or to have certain other mental disorders that are important risk factors for suicide among persons in all age groups, says the CDC. This reality has motivated research on other preventable risk factors for suicide among young people.

“One risk factor that has emerged from this research is suicide ‘contagion,’ a process by which exposure to the suicide or suicidal behavior of one or more persons influences others to commit or attempt suicide,” the CDC explains. “Evidence suggests that the effect of contagion is not confined to suicides occurring in discrete geographic areas. In particular, nonfictional newspaper and television coverage of suicide has been associated with a statistically significant excess of suicides. The effect of contagion appears to be strongest among adolescents, and several well publicized ‘clusters’ among young persons have occurred.”

How to talk about suicide

According to the National Alliance on Mental Illness, there are three primary tips to follow when discussing suicide with peers or on social media:

Colloquial as the phrase “committed suicide” has become, it’s inappropriate because it’s largely linked to the Catholic doctrine that suicide is a mortal sin. So by saying someone “committed suicide,” you can unintentionally imply that this person committed a kind of crime.

Excluding graphic details of the way someone took their life is advised because doing so can glamorize the act, and become triggering for those who are living with depression or suicidal ideation. The same principle applies to describing suicide notes, or locations of death, which can be especially damaging when the person who has taken their life is famous, as the general public’s fixation with learning all the details can easily make the tragic, deeply complex act seem more like a television drama.

How to write about suicide as a reporter and on social media

The imperative to discuss suicide safely is particularly important for journalists, as media descriptions feed impressions of a public figure’s death. According to ReportingOnSuicide.org, “more than 50 research studies worldwide have found that certain types of news coverage can increase the likelihood of suicide in vulnerable individuals. The magnitude of the increase is related to the amount, duration, and prominence of coverage.”

Organizations such as Samaritans and the CDC, provide highly specific media guidelines and the research behind why careful language can help prevent contagion. Here are some of the most-cited guidelines reporters, producers and social media contributors should follow:

Keep your writing concise and factual. This helps avoid simplistic explanations for suicide. “Suicide is never the result of a single factor or event, but rather results from a complex interaction of many factors and usually involves a history of psychosocial problems,” explains the CDC. “Public officials and the media should carefully explain that the final precipitating event was not the only cause of a given suicide. Most persons who have committed suicide have had a history of problems that may not have been acknowledged during the acute aftermath of the suicide. Cataloguing the problems that could have played a causative role in a suicide is not necessary, but acknowledgment of these problems is recommended.”

Do not glorify or sensationalize suicide. “News coverage is less likely to contribute to suicide contagion when reports of community expressions of grief (e.g., public eulogies, flying flags at half-mast, and erecting permanent public memorials) are minimized. Such actions may contribute to suicide contagion by suggesting to susceptible persons that society is honoring the suicidal behavior of the deceased person, rather than mourning the person’s death,” the CDC continues. The CDC cites the danger of repetitive and ongoing coverage and the presentation of details or dramatic photographs related to the suicide, including photographs of the funeral, the deceased person’s bedroom, or the site of the suicide.

Do not only focus on the deceased person’s positive qualities. “For example, friends or teachers may be quoted as saying the deceased person ‘was a great kid’ or ‘had a bright future,’ and they avoid mentioning the troubles and problems that the deceased person experienced,” writes the CDC. “As a result, statements venerating the deceased person are often reported in the news. However, if the suicide completer’s problems are not acknowledged in the presence of these laudatory statements, suicidal behavior may appear attractive to other at-risk persons—especially those who rarely receive positive reinforcement for desirable behaviors.”

Highlight research based on data. Instead of referring to recent suicides as “epidemic” or “skyrocketing,” describing a suicide as inexplicable or “without warning,” or quoting and interviewing police or first responders about the causes of suicide, discuss suicide as a public health issue backed by the most recent CDC statistics and less colorful words like ‘”rise” or “higher,” ReportingOnSuicide.org advises. Avoid oversimplifying the causes or perceived triggers of suicide—like a single accident, loss of job, breakup, or bereavement.

While some people who die by suicide do not display warning signs, the vast majority do. Share links to organizations like the National Alliance on Mental Illness, which provide detailed education on suicide warning signs and risk factors.

Provide suicide prevention resources. While people often avoid discussing mental health issues, talking about suicide is key to preventing it. Any reporting on suicide should include the message that depression is treatable, suicide is preventable, and ending the stigma around mental health requires honest dialogue. Resources such as Crisis Text Line and the American Foundation for Suicide Prevention provide education, resources, and crisis intervention. These resources are free of charge and available any hour of the day:

Complete Article HERE!

Veteran? Terminally Ill? Want Death With Dignity? That Could Get You Evicted.

By JoNel Aleccia

[C]alifornia voters passed a law two years ago that allows terminally ill people to take lethal drugs to end their lives, but controversy is growing over a newer rule that effectively bans that option in the state’s eight veterans’ homes.

Proponents of medical aid-in-dying and residents of the Veterans Home of California-Yountville — the largest in the nation — are protesting a regulation passed last year by the California Department of Veterans Affairs, or CalVet, that requires that anyone living in the facilities must be discharged if they intend to use the law.

That’s a position shared by most — but not all — states where aid-in-dying is allowed. As more U.S. jurisdictions consider whether to legalize the practice, the status of terminally ill veterans living in state-run homes will loom large.

“It would be a terrible hardship, because I have no place to go,” said Bob Sloan, 73, who suffers from congestive heart failure and other serious cardiac problems. He said he intends to seek medical aid-in-dying if doctors certify he has six months or less to live.

“I’m not going to be a vegetable,” said Sloan, a Vietnam War-era veteran who moved into the Yountville center five years ago. “I’m not going to end up living in so much pain it’s unbearable.”

A CalVet official said the agency adopted the rule to avoid violating a federal statute that prohibits using U.S. government resources for physician-assisted death. Otherwise, the agency would jeopardize nearly $68 million in federal funds that helps run the facilities, said June Iljana, CalVet’s deputy secretary of communications.

California is not alone. Three other states where aid-in-dying is legal — Oregon, Colorado and Vermont — all prohibit use of lethal medications in state-run veterans’ homes.

In Montana, where aid-in-dying is allowed under a state Supreme Court ruling, officials didn’t respond to multiple requests about whether veterans would be able to use the law in the residences. However, Dr. Eric Kress, a Missoula physician who prescribes the lethal medication, says he has transferred patients to hospice, to relatives’ homes, even to extended-stay hotels to avoid conflict.

In Washington, D.C., where an aid-in-dying law took effect last summer, the Armed Forces Retirement Home won’t assist patients in any way. Those who wish to use the law would be referred to an ethics committee for individual consideration, spokesman Christopher Kelly said in an email.

Only Washington state has a policy that allows veterans to remain in government-run residences if they intend to ingest lethal medications.. At least one veteran has died in a state-run home using that law, said Heidi Audette, a spokeswoman for the state’s Department of Veterans Affairs.

Paul Sherbo, a spokesman for the U.S. Department of Veterans Affairs, said the choice is up to the states.

“VA does not mandate how states comply with federal law,” Sherbo said in an email. “There are a number of ways individual states can choose to handle such situations and still be in compliance.”

To date, none of the 2,400 residents of California’s veterans homes has formally requested medical aid-in-dying, said Iljana. That includes the more than 900 residents of the Yountville center, located about 60 miles north of San Francisco.

“We would respectfully and compassionately assist them in transferring to a hospice, family home or other location,” Iljana said in an email. “We will readmit them immediately if they change their minds.”

But Kathryn Tucker, executive director of the End of Life Liberty Project, an advocacy group that supports aid-in-dying, said that CalVet is interpreting the federal regulations too broadly and denying terminally ill veterans the right to choose a “peaceful death” through medical assistance.

“Nothing exists in the federal statute’s language that would prohibit a resident from receiving aid-in-dying services at state homes, so long as they are not provided using federal funds or employees,” she said.

Ed Warren, head of the Allied Council, a group representing veterans at the Yountville site, co-signed a letter to CalVet officials protesting the ruling.

“My point of view is that it is inhumane to expect people in the last stages of dying to go through the hullabaloo of leaving their homes,” he said.

In Washington state, a 60-year-old man diagnosed with terminal chronic obstructive pulmonary disease, or COPD, died in June 2015 after ingesting lethal drugs at the Washington Soldiers Home in Orting, where he lived.

“It was all done very much in the open,” said Chris Fruitrich, a volunteer with the group End of Life Washington, which assisted the man.

There has been no indication that the policy jeopardizes the nearly $47 million the agency receives each year in federal funds, said Audette, the state VA spokeswoman.

In California, additional protests have centered on allegations that CalVet suppressed information about the aid-in-dying law.

Critics at the Yountville home contend that CalVet passed the discharge rule quietly, with little public input. Then the agency refused to broadcast a public meeting about medical aid-in-dying on KVET, the center’s state-run, closed-circuit television station.

Iljana said the Aug. 21 meeting, led by Tucker and Dr. Robert Brody, also a supporter of aid-in-dying, violated state rules that prohibit using public resources to promote political causes.

“Free speech is great and criticizing the government is great, but not using the government’s own resources and paid staff to advocate for a change in the law,” Iljana wrote in an email to prohibit the broadcast.

That decision, however, prompted Jac Warren, 81, who has been KVET’s station manager for eight years, to resign last month in protest, citing censorship.

“What is at issue is whether a state may completely suppress the dissemination of concededly truthful information about entirely lawful activity,” Warren wrote in an email to CalVet.

The hour-long meeting, attended by about 50 people, was not propaganda, Tucker said, but “an educational event with information provided by an attorney and a physician who both specialize in their respective fields in end-of-life care.”

Bob Sloan, who works as an engineer at KVET for a $400 monthly stipend, disagreed with the decision not to broadcast the meeting on the system that serves residents of the Yountville home.

Sloan said he knows other residents who would like to be able to use California’s aid-in-dying law if their illnesses progress.

“The only other option that people have in this state is committing suicide,” he said. “If I can’t find some way of doing it legally, I’ll do it illegally.”

Complete Article HERE!

Musings on Mortality: Difference between suicide, medical aid in dying

By Deborah Alecson

There is a profound difference between suicide and medical aid in dying, otherwise known as death with dignity. It is not a matter of semantics.

Death with Dignity Campaign

In a death-phobic culture such as ours, one in which we prevent ourselves from projecting into our dying time, we cannot grasp the distinction. True, both result in the taking of one’s own life, but one is an act of desperation and self-destruction, while the other is an act of self-love. How can choosing death over life be motivated by self-love, you are wondering. We will explore this later in the column.

People commit suicide often in the prime of their lives because living for them is unbearable. Unlike the terminally ill who choose medical aid in dying, people who seek to commit suicide are not in their dying time but in their living time. More often than not, there are underlying and unresolvable emotional and psychological torments. There is depression or a psychiatric illness that has not been or cannot be treated. For the elderly, suicide can be motivated by the suffering that comes from living a compromised life without the support of family, friends, or community. Loneliness and feelings of abandonment are factors in suicide, especially for the elderly.

Suicide is considered a failure of the person and of our society. Help was needed and not found. In our culture, suicide is to be prevented at all costs including the involuntary psychiatric hospitalization (or incarceration depending on how you view that which is “involuntary”) of the person who discloses his or her suicidal thoughts. There are consequences for a patient in therapy to even talk about suicide: The therapist must report him or her to the authorities. The horrible irony is that the one place a suicidal person can get help to understand his or her own feelings, with a therapist, is the one place where he or she can’t talk about these feelings.

In a death-phobic culture, thoughts of suicide are considered aberrant. But let’s be honest, who hasn’t thought about suicide at least once in their life?

The will to live is an instinct of such force that human beings kill other human beings to stay alive. Human beings accept life-prolonging treatments during what would be their natural dying time that in the end, diminish the quality of time that they had bought with more treatment. People will do unbelievable things to ensure their own survival.

So, choosing to die under the weight of the instinctual and societal will to live is either accomplished out of sheer terror of life itself or incredible courage. Courage to venture into the unknown.

Since most of us have not been around dying people and as I wrote earlier, rarely imagine ourselves in that situation, we have no idea what dying is like. We don’t understand what it asks of us and what it takes out of us. While hospice care can be a possibility for how we live our dying time, it is not for everyone.

Medical aid in dying is now possible in five states. This means that people who are dying of a terminal illness can request a lethal dose of medication to end their own lives. Those few terminally ill patients who request and qualify for medical aid in dying do so to have a dignified death on their own terms. That’s all. This choice is a logical, sound, and deeply compassionate act of relief, not a desperate escape of a circumstantial situation as suicide often can be.

How can choosing death over life be motivated by self-love? When your dying time comes, you may want to spare yourself and your loved ones a prolonged and brutal decline. This to me is self-love. It is not suicide.

Complete Article HERE!