We discussed “gifts of grief” in an earlier post (August 27, 2014). Out of the sad death of Robin William’s we have received a gift of grief. His death by suicide has created and allowed much discussion about and awareness of this misunderstood disease. We can now talk about suicide, a formerly taboo subject, out loud and in public. We have overcome the myth that talking about suicide might give someone an idea. We are beginning to take away the stigma associated with a death by suicide.
Suicide is a sensitive and complex subject. I will not attempt to discuss every aspect of suicide in this post but will concentrate on these three areas:
- How death by suicide is so misunderstood.
- How to help bereaved survivors of suicide.
- How to prevent further deaths by suicide.
1. How death by suicide is so misunderstood.
There is a considerable amount of misunderstanding surrounding death by suicide. Some people are of the “opinion” that suicide is a selfish act. Others are quick to judge and call the act of suicide cowardly.
In his book Out of the Nightmare, Dr. David L. Conroy, Ph.D writes, “Suicide is not chosen; it occurs when the pain exceeds the resources for dealing with the pain. The website www.suicide.org dedicated to suicide prevention, awareness and support insists that suicide is NOT a selfish act but an act of desperation by someone in intense pain. Most people who die by suicide have a skewed perception of reality. They perceive themselves as a burden. No amount of convincing can change their perception.
Edwin Shneidman, a clinical psychologist who is a leading authority on this topic wrote in his book The Suicidal Mind that “the common purpose of suicide is to seek a solution.” A suicidal person is seeking a way to end intense, unbearable suffering and suicide is a resolution to an otherwise unsolvable problem.
Our whole selves are made of mind, body and spirit. This blog’s logo represents these three parts of our whole being and the goal is to heal in mind, body and spirit. Any of these three parts can fail at any time. We seem to understand and accept a death when the physical body breaks down but a death from mental or spiritual illness is a mystery and more difficult for us to understand. For those who call the act of suicide selfish or cowardly consider this analogy. If you have never battled cancer and the accompanying chemotherapy treatments then you cannot have an opinion on what that may or may not feel like. Similarly, if you do not suffer from mental illness you cannot have an opinion or idea how painful life can be for those who do. The act of suicide is not a choice, just as cancer is not a choice.
Over 95% of deaths by suicide involve mental illness, including depression. Most of the recent articles about Robin William’s death by suicide were written by journalists who they themselves admitted to suffering from depression. These authors could relate to the extreme pain Williams and others suffering from mental illness experience. The writers’ honesty allows a perspective for those who do not battle depression or other mental illness and give us an insight when trying to fathom how bad things could be to die by suicide.
As a bereavement coordinator I attended the funeral of a forty year old single male who had died by suicide. This young man died by strangulation in his parent’s garage. In planning the funeral the family openly shared the cause of death and talked about the demons their son and brother faced. At the luncheon after the funeral, the sister of the deceased spoke briefly to thank those in attendance. To my surprise, the sister continued by stating to all those present that her brother was sick in that he suffered from mental illness. She shared that her brother’s suffering was so intense that to him his only option to escape the pain was to end his life. She asked that they understand that her brother died from a disease and that he was not a freak or a coward. She encouraged all those present to visit and support her parents. By talking openly and honestly about her brother, his illness and the nature of his death, this young lady helped all those present to begin to understand the very complicated nature of suicide.
2. How to help bereaved survivors of suicide.
If you take away one nugget of information from this blog post about suicide…let it be this…the BEST way to help a survivor of suicide is by listening to them in a non- judgmental way. How do you do this? You show up, you make yourself present and you listen! Survivors of suicide need to express their hurt but since death by suicide has such a stigma associated with it, people don’t know how to react, and the bereaved are often left alone feeling isolated and outcast. The healing process can begin only once the bereaved can tell their story over and over again and know that they are not being judged.
As a volunteer on a Dental/Educational Mission in Mexico for El Nino Rey (www.elninorey.org), I experienced firsthand this lesson of showing up and being present. After a week of dental and scholarship missionary work in the rural mountains of Guerrero, the team celebrated Mass at a home in Acapulco. A Mexican woman who was an employee of the homeowner attended Mass. She had previously shared (in Spanish) to the priest that her teenage daughter had died by suicide two years ago. Fr. asked her to bring a picture of her daughter to place on our makeshift altar on the living room table. Fr. talked about and included prayers for the woman and her deceased daughter in the Mass. It was a moving and powerful experience for our mission team and for this woman. This was the first time since her daughter’s death two years ago that she was able to “tell her story” and talk about her daughter and truly grieve! As a bereavement coordinator I felt compelled to respond to the woman in her grief. Initially, I was frustrated that I could not speak fluent Spanish and talk to her, console her and ask questions about her daughter. However, I remembered the most helpful and important task is to show up, be present and listen. I stayed by this woman and held her hand. Together we smiled, cried and gazed at her daughter’s photo. Words were not necessary to communicate love, support, care and concern. This encounter was a strong lesson and reinforcement that the best gift we can give the bereaved is our non-judgmental presence.
Grieving the death of loved one who died by suicide is lonely. Survivors feel marked and at the same time the pain of grief is intense, relentless, perilous, heart-breaking, and gut-wrenching. Show up, be present, listen and say the deceased person’s name. The family will want to hear it and you will be helping them to move forward to heal in mind, body and spirit.
3. How to prevent further deaths by suicide.
An extremely high risk factor in death by suicide is hopelessness. How do we identify hopelessness? Look for these signs:
- Talk of wanting to die.
- Talk of buying a gun.
- Talk of being a burden to others.
- Talk of being in incredible pain.
- Increase use of alcohol or drugs.
- Increase/decrease sleep.
- Decrease socialization.
- Increase in extreme mood swings.
It is extremely important to note that people who die by suicide usually talk about it first. We turn once again to Edwin Shneidman’s The Suicidal Mind to see that “the common interpersonal act in suicide is communication of intention.” It is a myth that people who really want to kill themselves don’t talk about it. Most people who attempt suicide have told other people about their plans.
During an interview for a hospice chaplaincy position the director asked me what I would do if I went to visit a patient and the patient talked about what a burden they had become to their families and how they just wanted to end it all.
My response was that once I got back to the office I would alert the family about this conversation and also notify the hospice team. “WRONG!” The director said. The correct response is to ask the patient this question, “Do you have a plan?” The director continued to educate me on how people who have developed a plan of suicide are at a high risk of actually attempting suicide. If the individual indicates that yes there is a plan in place then that person should not be left alone.
As I listened to the director, I could not imagine myself to ever be in a situation where I would need to ask someone if they had a plan of suicide. But I thought it was good to be educated on how to respond. Fast forward a few months to a grief support group for widow and widowers. One of the participants who had been attending grief support for a few months was very distraught over the death of her husband. At some point during the meeting she stood up and ran out of the room screaming and crying that she just couldn’t live without her husband and that she wanted to die. I followed her out of the room and found her in the hallway curled up in the fetal position crying and saying she just wanted to die. I stayed with her and held this woman while she cried. After some time when things calmed down and she said she was okay to drive home, I knew I had to ask her a question before I let her go. Did she have a plan? When I questioned her, she looked at me and said, “Oh, I wouldn’t ever end my life! I don’t have the courage to do that and I wouldn’t want to hurt my grand-daughter.”
Since then I have had to ask that question several times. I realize how important those five little words are in a crisis situation. Just like I had to do, get comfortable with asking a friend/co-worker/family member/neighbor who is talking about suicide, do you have a plan? You may save a life.
Sometimes when a person demonstrates warning signs of suicide it is necessary to ask them to sign a No-Suicide Contract. This is a signed formal agreement where the person with suicidal tendencies agrees to not kill himself or any other person and to reach out for help if suicidal thoughts intensify. Is it guaranteed to stop someone from attempting suicide? No, but it is a conscious reminder that someone cares and it holds the person accountable. It has proven to be effective in many cases.
Suicide awareness and education will help prevent further deaths. Look for warning signs and start talking out loud and in public about suicide. In doing so, we will take away the stigma of suicide, become educated about the topic, prevent further suicides and in doing so we will honor Robin Williams and all others who have suffered and died by suicide.