GRIEF AFTER SUICIDE: The Journey of Survivors

1. GRIEF AFTER SUICIDE:The Journey of Survivors John R. Jordan, Ph.D. Pawtucket, RI

2. Overview • Introduction • Suicide “101” • Common Myths About Grief • How Is Grief After Suicide Different? • How Can I Survive? • Wrap-up

3. Suicide Epidemiology • Males Complete Suicide at a Rate 4 Times That Of Females • Highest Suicide Rates Are Generally for Elderly, Isolated Males • Highest # Suicide Completions Are for Middle-aged Males • Ethnicity • In both U.S. & Canada, highest rates by far are for Indigenous Peoples • 90% Have Diagnosable Psychiatric Disorder - Most Often Mood Disorders

4. Suicide Epidemiology • Suicide Is A Public Health Problem • About 38,000 Completions/ Year in U.S. - 2010 • 700,000 – 1,000,000 Attempts/ Year in U.S. • 20-25 attempts for every completion • Worldwide - Nearly 1 Million Completions/ Year, 20 Million Attempts/ Year • 10th Leading Cause Of Death in U.S., 3rd For Young People (15-24)

5. Suicide Etiology:Suicide as the “Perfect Storm” • Genetic Factors • Biological Factors • Low neurotransmitters • Certain medical disorders • Epilepsy • TBI • Personality • Past Experience • Trauma

6. Suicide Etiology:Suicide as the “Perfect Storm” • Life Stressors • Interpersonal loss (particularly suicide) • Role status loss • Interpersonal Connectedness • Social Issues • Opportunity/ Access to Means

7. Common Myths About Grief • Myth: Grief Happens In Stages • Instead, grief is cyclical or wave-like • Myth: Grief Is The Same For Everyone (Men, Women, Adults, Children) • Instead, grief is very individual

8. Common Myths About Grief • Myth: Time Heals All Wounds - It Should Take About a Year • Instead, different aspects of grief take different amounts of time • There are significant individual differences • What matters is the direction of the trend, not the time it takes • Myth: Time Heals All Wounds – Just Wait It Out • Instead, grief involves active self-care • Grief involves acquisition of new skills of caring for yourself after emotional injury

9. Common Myths About Grief • Myth: Grief Involves Saying Good-Bye and Achieving “Resolution” of Your Grief • Instead, we keep continuing bonds with our dead • “Your task is not to let go, it is to find a different way to hold on” • Goal = learning to “carry the boulder”, not “put it down”

10. HOW IS GRIEF AFTER SUICIDE DIFFERENT?

11. Prominent Themes For Survivors WHY? - Making Sense of the Death RESPONSIBILITY - Guilt & Blame SOCIAL DISRUPTION - Isolation SHAME - Stigma ANGER - Rejection & Abandonment 11

12. Prominent Themes For Survivors TRAUMA - Shock & Horror RELIEF - The End Of Suffering SUICIDALITY – Why Go On? SORROW – Grief & Yearning 12

13. Prominent Themes For Survivors: Family Impact • Information management – who to tell, and what • Communication shut-down • Trying not to upset others • Anger/ conflict management • Disruption of family routines/rituals • Loss of cohesion

14. Prominent Themes For Survivors: Family Impact • Coping Asynchrony - Differences in grieving styles & change in availability • Blame/scapegoating • Anxiety about it happening again (esp. for parents) – problems with separations – “Are we cursed?”

15. Post-Traumatic Growth After Suicide Changed identity Changed relations with others Changed outlook on life Growth 15

16. HOW CAN I SURVIVE? • Self- Care • Body • Mind • Spirit • Educate Yourself • About suicide • About grief • About trauma • Lower Your Expectations • “One day at a time” • Be With People Who “Get-It”, Avoid Those Who Don’t • Be wary of “know - it - alls” • Be wary of “know – nothings” • Be with people who walk along with you

17. How Can I Survive? • Trial & Error Healing • Expect coping differences - Go outside the family • Multiple pathways towards healing • Learn to “dose” your grief • Try familiarity – re-establish routines • Try novelty – try something new • “Don’t Waste Your Grief” - Engage in activities that: • Honor the life of your loved one • Keep their memory alive • Give a purpose and focus to your grief • Be Patient • Have Faith in Your Resilience!

18. When to Seek Professional Help • The trend of your grief is more important than the speed • Up is “green” • Flat is “yellow” • Down is “red” • When coping methods are self or other-destructive • Particularly, suicidality • PTSD symptoms • Intrusive re-living • Avoidance (getting worse) • Physically “wired” or “emotional numbness”

19. When to Seek Professional Help • Prolonged Grief Disorder • Unending grief/ yearning • Trouble re-investing in life • Loss of meaning/purpose • Prolonged difficulty with acceptance of the reality • Severe depression • Anhedonia (inability to feel pleasure) is getting worse • Sleep, appetite, energy staying dysregulated • Loss of functionality • Active suicidality • Others are consistently saying “Please get some help”

20. Types of Help for Survivors • Survivor outreach programs • Survivor to Survivor Network • Samaritans – www.samaritanshope.org • Individual therapy • Family/Couples counseling • Support groups • SafePlace groups • Samaritans – www.samaritanshope.org • Activism

21. HOW CAN FRIENDS, FAMILIES, AND COMMUNITIES HELP?

22. How Can Friends, Families, & Communities Help? • When in Doubt, Reach Out! • Offer the “Gift of Presence” • Don’t assume you know what this means • “Don’t say too much” • Offer Assistance • Practical help • Help find resources • Stay in for the long haul • Keep in touch – be available, but not intrusive • Keep asking “How is this for you? • Remember anniversaries

23. How Can Friends, Families, & Communities Help? • Education of first responders • Education of clinicians • Support development of community resources • Information for new survivors • Outreach teams • Linkages between survivors • Eg., AFSP National Survivor Day Conference • Opportunities for activism • Eg., Community Suicide Prevention Council • Support groups

24. Wrap-Up • Questions? • Comments?

25. 3 WISHES – Over Time,That You Will Be Able To: • Make Your Peace With the Suicide • Remember and Honor the Life of Your Loved One • Find Courage, Strength, & Serenity as You Go Forward