Thinking of you, survivors of suicide loss

November 23, is International Survivors of Suicide Loss Day. According to the World Health Organization, around the globe, on average there is one suicide every 40 seconds.

If you are a survivor yourself or you know someone or know someone who knows someone who lost someone to suicide. Suicide stops us in our tracks. It can be hard to wrap our heads around that much pain and anguish.

Suicide research originally indicated that each suicide left, on average, six people in its wake. However, there are new indications that each suicide could leave 22-26 people in its wake. The higher number is not surprising when you think of coworkers, classmates, neighbors and the like.

We humans are social beings. Our lives are filled with connections and relationships. It is hard to see our loved ones, friends or coworkers doubled over in grief and pain. We want to do something – anything — to help ease their misery.

And if you are a survivor yourself, you know all too well how treacherous the path is out of the well of complicated and traumatic grief from a death by suicide.

To help you as well as to help others, here are eight articles that hopefully will expand your understanding  and assist you in caring for those you love who are heartbroken:

When You Are the Survivor of Suicide

 This is What Grief Feels Like 

Understanding Teen Suicide Helps Make Sense of the Heartbreak

7 Things You Need to Know after a Loss from Suicide

When You Are Ready, This Can Help You Heal from a Loss by Suicide

Dealing with the Death of a Young Person

How to Help your Grieving Child

Shattered Hearts: Explaining Suicide to Children

Thinking of all of you who have walked this path, directly and indirectly. May your heart find peace.

Understanding Intolerance, Bullying And Suicide

Intolerance is a battering ram directed at anyone who is perceived as different and who has therefore become a focus of enmity. You want them to be like you. If they are not like you, you have things to say and you might become enraged, disgusted and afraid — all of this in the name of like-mindedness.

They, those other ones, become your enemy and the focus of your attention as you rain down your vitriol on their different-from-you selves. They, those other ones, become fair game for your averted eyes, comments, slurs, stares, grimaces, cold shoulders, bullying, graffiti, hate crimes, attacks, thefts and warheads.

Intolerance is predicated on fear. “Otherness” has scared people for centuries. Wars and conversion missions have been started in the name of homogeneity: Be like me and then we can understand each other. Intolerance smacks of fundamentalism: I’m right, and you’re wrong. It seems there can be no middle ground, and no acceptance of the other.

Many a suicide happens because of this rampage of intolerance. The horror of bullying is a prime example, a universal phenomenon, and it is just beginning to get the attention it deserves.

There are three kinds of bullying: verbal, physical and social, with verbal abuse being the most common. Bullying includes physical bullying, emotional bullying, and cyber-bullying (i.e., bullying on the Internet, and circulating suggestive or nude photos or messages about someone).

According to studies by Yale University, bullying victims are two to nine times more likely to consider suicide than their non-bullied classmates. A study in the U.K. found that at least half of the suicides among young people are related to bullying. Further, ABC News (U.S.) reported statistics that showed nearly 30 per cent of students are either bullies or victims of bullying. Some 160,000 students stay home from school every day because of fear of bullying.

Kids are bullied because they are different, and they can be different in any possible way. If you are different you can be picked on, and you become a potential target. Parents of bullied kids will sometimes go to extreme measures to help their children avoid bullying: one first grader was given plastic surgery to have her ears pinned back.

Kids are bullied for any number of reasons. Common “differences” that can draw unwanted negative attention include:

• Having an unusual appearance or body size
• Showing behaviors of attention-deficit/hyperactive disorder (ADHD)
• Being diabetic
• Being gay
• Being a gifted student
• Having food allergies
• Displaying a noticeably high level of anxiety
• Having learning disabilities
• Having medical conditions that affect appearance
• Being obese
• Stuttering

It’s easy to understand that bullying leads to shattered self-esteem, poor self-worth, depression and suicidal thoughts or actions. Bullying can have long-term emotional ramifications for the victim. Further, a number of school shootings — for example, Columbine — have been caused by bullied kids seeking revenge. Bullying is a symptom of intolerance that escalates and becomes a vicious cycle.

So much suicide is a result of intolerance. Think of all the heartache that is caused by simply not accepting people for who they are and where there are. Intolerance is a mighty powerful belief system. It prevents peace, contributes to suicidality, and causes pain across the globe.

Let’s make bullying an intolerable. Let’s teach our children. Let’s model tolerant and compassionate behavior and tip the societal balance in favor of understanding and acceptance.

 

This post was also featured on The Huffington Post Canada.

The three common elements of suicide

From my perspective, all suicidal gestures and actions, no matter how large or small, injurious or lethal, share these three elements:

  • Pain
  • Disconnection
  • Disenfranchisement

Pain
Pain means any and all pain in all its permutations—be it physical, emotional, mental, spiritual, or any combination thereof. Pain hurts. When we are in pain, we have one goal: to stop hurting. We do everything we can to get out of pain. Often, we don’t care what it takes to be pain-free; we just want the howling, can’t-take-a-deep-breath or think-clearly pain to be over as soon as possible.

Constant, chronic pain—of any variety—changes people. Pain is exhausting and debilitating. Pain makes us cranky and intolerant. Pain wreaks havoc with our sleep cycle. It rearranges our thinking as well as diminishes our ability to cope and withstand the vagaries of everyday life.

When we are in pain, we contract into ourselves. Our world becomes smaller, darker, and enclosed. We shut out the world. There is only so much bandwidth, and we use it to manage the pain. The only thing that matters is to be pain-free, now. And, unfortunately, that can sometimes result in a suicidal action.

Disconnection
Disconnection speaks to the separation between the self and others. Separation is the operative word. We feel unwanted and unloved, alone and isolated, misunderstood and alien. There may be no one in our corner or no sense of connection with another person, a group of people, or a higher power. We can even feel profoundly disconnected among family and friends, who do not understand us and, more pointedly, do not comprehend what we have experienced and what has happened to us. This can be the height of loneliness.

We know from research that people who feel socially isolated (i.e., divorced, widowed, etc.) are at increased risk for suicide as compared with those who have responsibility for family members and are part of some kind of social grouping, network, or organization.

With disconnection, it feels as if there is no tether to stay anchored and grounded on the earth plane. We are alone. No one gets us. This is particularly true of survivors of a suicide loss, the military and veterans, and survivors of childhood sexual abuse.

Disenfranchisement
Disenfranchisement, in the psychological sense, is disconnection to the nth degree. It is the ultimate sense of disconnection; it’s as if we are looking at the world with our nose pressed to the glass. We do not feel that we belong, nor are we connected in any larger sense. We are no longer a part of the whole. We are a free-floating entity adrift in the world, alone, without value, purpose, or plan. There is no meaning in our life. We feel invisible and worth nothing. This is the utmost of pain.

All three elements — pain, disconnection, and disenfranchisement — take us to shut-down, closed-off places. This leads to inactivity, inertia, passivity, and powerlessness. We feel stuck. We have lost our abilities to be creative and expansive. There is precious little energy or flow. And, from that position, it is easy to become dispirited and hopeless, which is another kind of pain. And pain of all kinds can lead to suicidal thinking and action.

Suicide is a complicated and multi-factored issue, and yet there are three common elements that serve as the foundation to suicidality. These elements address the full spectrum of suicide. They can help us understand the ineffable “why” of suicide and, also, serve as warning flags for the future.

These three elements also underscore our need to find better ways to reach out and provide safety nets, support, and aid for our most vulnerable and traumatized.

Suicide and brain damage

The brain is doubly impacted by trauma and addiction. We also know that organic brain disease may increase suicidality, and there are worrisome side effects that come with certain psych meds. Soldiers, football players, boxers, other high-impact sports athletes, car accident victims, and others who have had a traumatic brain injury (TBI) or its milder form, post-concussion syndrome (PCS), are at risk.

Traumatic Brain Injury has two causes:

1. Penetration of the head by a foreign object, such as a gunshot or sharp object.
2. Strong jostling within the cranium from a fall, a blow to the head, a car or motorcycle accident, etc.

The hallmarks of TBI, depending upon the severity of the blow to the head, can be:

• Cognitive impairment, evidenced in poor memory and lack of focus
• Emotional problems, such as depression, anxiety, personality change, aggression, and impulse control
• Impaired motor function, poor balance and coordination, and weakness in the extremities
• Problems with vision, hearing, and touch as well as impaired perception

NFL player Dave Duerson, former star of the Chicago Bears, shot himself in the chest at age 50. Before taking his life with a self-inflicted gunshot wound to the chest, he texted his family, asking that his brain be given to Boston University School of Medicine to be used for research—which is why he shot himself in the chest rather than in the head.

Researchers in neurology discovered that Duerson suffered from a neurodegenerative disease called CTE (chronic traumatic encephalopathy), which is linked to repeated head trauma and promotes the growth of a protein that is prevalent in degenerating brains like those with Alzheimer’s disease. The symptoms of CTE include suicidality, depression, aggression, and impaired judgment.

In 2006, another NFL player, Andre Waters of the Philadelphia Eagles, ended his life at the age of 44. The forensic pathologist who studied Waters’s brain said that it resembled the brain of an 85-year-old man in the first stages of Alzheimer’s.

The current research indicates that CTE is also found among military veterans and young school athletes, including those who play hockey and football, who take repeated blows to head. The soft-tissue damage to the brain is cumulative and dangerous.

Most significantly, the brain damage caused by CTE and TBI can lead to suicide.

A word about substance abuse, addiction and suicide

Research tells us the following:
• Drugs and alcohol increase the risk of death by suicide more than six times.
• The largest risk factors for suicidal thoughts are depression and other mental disorders, and substance abuse.
• More than one in three people who die from suicide are intoxicated, most commonly with alcohol or opiates (i.e., heroin, oxycodone).

Addiction is a brain disorder, not merely a matter of willpower. The brain is held hostage by drugs and alcohol. It is a real disease that is both cunning and baffling. And, it is treatable.

The abuse of substances, drugs and/or alcohol, leads to ignoring your responsibilities, taking risks, relationship problems, and potential legal issues. You are using substances without concern for their impact. It’s a bit like you have begun an unhealthy love affair. You are not quite yourself; you don’t care what others say, and you become more and more entranced with your new “love.” Slowly, and most certainly, you hand your power over to the substances of your choice.

Full-blown addiction harms the body, makes changes in the brain, results in poor life choices, and batters relationships. Addiction also increases feelings of self-hate, shame, isolation, and scheming behaviors. It erodes the spirit. Your life totally revolves around making connections, getting the substance of your choice, using that substance, and recovering from its use. Yet, you continue to use the drugs and/or alcohol even though you know it is bad for you. You are powerless, and the substances now own you.

Why do suicide, substance abuse, and addiction frequently go hand-in-hand?

We know that substance abuse changes us physically, emotionally, and mentally in these ways:

• Decreases inhibitions and lowers defenses
• Increases aggressiveness and violent behavior
• Impairs judgment
• Increases impulsivity. (Adolescents and young adults, especially, feel “bullet-proof,” and that nothing bad could ever happen to them.)
• Amplifies emotional responses such as hopelessness, despair, shame, and abandonment
• Increases and exacerbates emotional fragility already present within certain populations, i.e., those who are dual diagnosed (mental illness + substance abuse) and those suffering with PTSD and traumatic brain injury (TBI)

We know that substance abuse changes the brain. It impacts thoughts, feelings, and actions. Frequently, substance abuse is an anesthetic, a maladaptive habit-pattern, a coping response for stress, pain, and unhappiness. For the emotionally vulnerable person, substance abuse is akin to a match near a can of gasoline. There is a much greater potential for disaster.

Suicide and the Power of Shame

Shame is a feeling state. It is a deep-down, red-faced humiliation and mortification with oneself.

Through the lens of shame, we look at ourselves with complete disgust, revulsion, and contemptibility. We judge ourselves harshly, and show no mercy. We see ourselves as the epitome of gross imperfection, enormous stupidity, complete failure, and abject incompetence. Shame is a powerful force, and it can be a driving factor in suicidal thinking.

Shame is associated with intense feelings of disgrace, dishonor, and condemnation. It is also a major component of ostracism, shunning (think Hester Prynne and her Scarlet “A”), and punishment.

Shame is not the same thing as embarrassment. When we are embarrassed we feel, in varying degrees, uncomfortable with ourselves for something we have done or experienced. We are discomfited by our behavior. For example, we look in a mirror and realize that we had a piece of spinach stuck to our front tooth during our dinner date as we laughed and acted charming.

Nor is shame the same as guilt. We feel guilty when we have violated our personal standard. For example, we forgot to send our favorite Aunt Minnie a birthday card or we didn’t check up on a sick friend.

The etymology of the word “shame” is rooted in the words “to cover up, hide.” And, that’s exactly what we do when we feel ashamed; we want to hide and cover up. We avert our eyes, lower our head, and our shoulders slump. We want to disappear. And when there is intense shame, there is vasodilation (blushing) along with increased body heat and warmth.

Like fear, shame is a learned response. No one is born with shame. Shame is passed along by super-critical parents, relatives, employers, teachers, and the like. They regularly make denigrating comments that make you feel horrible about yourself. You might hear that you are stupid, worthless, unlovable, ugly, fat, a failure, incompetent, and any number of put-downs that attack your very essence. These critical folks (from their own wounded and unhealed hearts) tell you these terrible things about yourself, and you believe them. You unconsciously absorb their personal poison and drink it in as truth. You forever feel not good enough, not lovable enough, not enough enough.

You can feel ashamed when you are stopped for a DUI (i.e., driving while intoxicated); are verbally abused in front of your co-workers; or tell your friends your father died of a heart attack when he actually died by suicide. You can feel shame when you learn you are infertile or you need to file for bankruptcy. You can be filled with shame and the attendant self-loathing after you rage at your children or realize you have sent a scathing email to the wrong person.

Perfectionists, understandably, carry a tremendous load of shame. Members of dysfunctional families where there is addiction, violence, anger, and control issues also live with shame every day of their lives. Shame is all too common in cases of child abuse and child neglect. And, we all carry the secret shame of being ashamed. Shame says, I am a bad person, a horrible person, a no-good person.

Brené Brown, PhD, LMSW, is a researcher and storyteller who studies vulnerability, courage, worthiness, and shame. (Check out her fab TED talks on shame and vulnerability.) Brown has discerned what she calls her 1-2-3’s of shame:

1. “Shame is universal. It is one of the most primitive of human emotions. The only people who don’t have shame are those who have no empathy and lack the capacity for human connection. Here’s your choice: Fess up to experiencing shame or admit that you’re a sociopath.”
2. “We are all afraid to talk about shame.”
3. “The less we talk about shame, the more control shame has over our lives.”

Further, Brown has identified 12 categories of shame:

• Addiction
• Aging
• Appearance and body image
• Being stereotyped or labeled
• Family
• Mental and physical health
• Money and work
• Motherhood/fatherhood
• Parenting
• Religion
• Sex
• Surviving trauma

Within each of these shame categories, we can see a link to suicidal thinking and behavior. Brown reminds us, “Shame is such a powerful emotion that it can literally overcome us.” It can. It does, and, alas, too frequently results in suicide.

Let us watch for and notice the pernicious and dangerous hold of shame. We can circumvent the slippery slope of shame with compassion, discussion and reality-testing. Shame is a powerful, soul-eroding emotion that distorts good minds and twists hearts.

MyNDTALK with Dr. Pamela Brewer

Making Peace with SuicideThis was a great interview with Dr. Pamela Brewer in which we discussed my book, Making Peace with Suicide: A Book of Hope, Understanding and Comfort. I told Dr. Brewer it felt like we were sitting in comfy chairs and sharing a cup of tea. This ranks as one of my favorite interviews.

Her show is called MyNDTALK with Dr Pamela Brewer. To listen to this broadcast, click on the link below. The show runs for about an hour. Enjoy!

        

       

Collateral damage

The 50 year-old American Association of Suicidology’s  (AAS) mission is, in brief, developing strategies to prevent suicide,  advancing education and scholarly work around suicide and, promoting research about and training in suicide. Edwin Schneidman, Ph.D., the founding President of AAS, said:

Survivors of suicide represent the largest mental health casualties related to suicide.

Of course, this is heartbreakingly true. Suicide leaves a wake of complicated grief and trauma. It is a hero’s journey to work through the emotional undertow and dig out of the dark hole to rebuild a shattered live.

The taboo has been broken. You are knee-deep in loss, shock and whirling feelings. It seems insurmountable. Your grief is debilitating; your pain is off-the-charts. It’s hard to breathe. You hold the thought of the very thing that has broken you as a possible way to end your own pain.

For your consideration, here is a link that you might find helpful about being a of a suicidal loss and another link about understanding the grief of suicide.

Go gently. It takes time. There will be a day when you can take a deep breath.

 

Thank you Step 12 Magazine for the great review!

12steps-magazine-issue-19-cover12stepsreview_4stars

This year, I have been talking about the interface of suicide, addiction and trauma. You can image my surprise and delight when those wonderful folks at Step 12 Magazine wrote a swell 4-star review of my book, Making Peace with Suicide: A Book of Hope, Understanding and Comfort. Thank you, Step 12 Magazine! I am over the moon and so grateful for both the good words and bringing this important topic forward.

Author Adele R. McDowell combines practical guidance with spirituality and a deep understanding of pain and grief, and trauma and its impact.

Adele has packed every aspect of losing a loved one to suicide into a single insightful, meaningful edition which should be read again and again.

Personal accounts of those who have attempted suicide, sometimes multiple times, from people who have leaned over the edge of the abyss but didn’t jump, show us how moving away from suicidal tendencies requires conscious choice and deliberate action.

Adele helps readers understand the complex factors involved when people choose to take their own lives, making it abundantly clear that society needs to find better ways to talk about and understand why people become so desperate to escape that they choose to end their own lives.

PS Click the Step 12 Magazine cover for more information on their wonderful publication.

Psychology Today: “When suicide hits home” by Susan McQuillan

BleedingHearts in Blue Free Creative CommonsThe following is an excellent Psychology Today blog post by Susan McQuillan looking at suicide and eating disorders:

The statistics are alarming. More than 40,000 Americans commit suicide every year. That averages out to about 110 people every day. Although it is the tenth leading cause of death overall, suicide is the second leading cause of death among those between the ages of 10 and 25 years old. Veterans make up 20 percent of all suicides.

Chronic physical and mental health problems underlie most attempts at suicide, although circumstantial and environmental factors can also contribute. As is true in the case of many psychiatric disorders, people with eating disorders are at higher-than-average risk of committing suicide, and those with anorexia nervosa have the highest risk of all.

Bonnie Brennan is the Senior Clinical Director of Adult Residential and Partial Hospital Services at Denver’s Eating Recovery Center (ERC), a national, vertically integrated, health-care system for eating disorders recovery. ERC provides comprehensive treatment for anorexia, bulimia, binge eating disorder, and other unspecified eating disorders. Brennan points out that the more severe or long-term the condition, the more isolated and burdensome the patient may feel, and that is when there may be more concern about the potential for suicide. Because the eating disorder population is often competitive, she adds, caregivers and families must be careful not to glamorize another’s suicide in any way, and to watch out for “copycat” suicides. In her experience working with people who have eating disorders, suicide occurs in various age groups, and the longer the course of the illness, the more despair the person may have about their ability to actually recover, which can lead to an increase in suicidal thoughts,

The entire family is often affected when someone has an eating disorder. Brennan emphasizes that family members are an important part of the healing process. Often their loved ones aren’t mature enough, or are too compromised by their illness, to take responsibility for themselves, so family members must step in. Brennan advocates for the support of the caregivers as well, since an eating disorder affects the entire family support system. The treatment facility provides support, resources and services that include educational workshops, skill building, dietary instruction, and family therapy. It can become a full-time job for family members to try to help manage the recovery program, Brennan points out, and when it all ends in suicide, family members are often left with very mixed emotions.

“When a loved one dies after a long, distressful illness, there is a sense of anger, sadness, and guilt jumbled together with other emotions,” she says. “They too have suddenly been released from the hold of this disease, and must now move on to the process of grieving.”

One Family’s Story

April Garlick, who lost her teenage son Justin to suicide in 2015, experienced the protracted grip of his eating disorder. As he reached his teens, Justin became a bit pudgy and was openly unhappy about his body, but then he hit a growth spurt and his weight evened out. Still, he began cutting back on food and exercising to the point where April felt he had what seemed like an addiction to running. At first, Justin rejected her suggestion of therapy but soon after, at 5’8” and 117 pounds, and experiencing bradycardia (abnormally slow heartbeat), he asked for help. He began counseling and soon his weight was up to 125 pounds. April remembers that he seemed happy this point, though she sensed he still wasn’t 100 percent.

But over the next year, as his self-esteem plummeted and his behavior became more and more irrational, it was clear that Justin was heading downhill. He fought more and more with family members, changed high schools and attempted online studies to try to keep up, and lost weight again. He went in and out of various treatment programs and at one point was on suicide watch. It was a proverbial roller coaster, not only for Justin but also for April, as she tired not only to battle his illness but to also battle her insurance company to try to get him the type of care he needed.

Throughout that year, there were occasional moments of happiness, where Justin felt he had a breakthrough and could say he was happy, but those feelings didn’t last. In the last phone call April got from Justin, he asked her to call 911 because he had badly hurt himself. He was taken away in an ambulance and April was told to meet them at the hospital. Although the doctors worked hard to save him, Justin did not make it.

Picking Up the Pieces

Dr. Adele Ryan McDowell, author of Making Peace with Suicide, describes the aftermath of suicide as “a complicated loss” for those who are left behind, especially for those who have lost a child. In addition to the trauma of what is often a sudden and unexpected death, and perhaps the burden of a broken taboo, friends and family members may experience deep feelings of anger. On top of the anger, there is often a layer of guilt. Though you did the best you could, you may judge yourself too harshly for your all-too-human responses and behavior toward the person you lost. The trauma of a loved one’s suicide may also trigger memories of other traumas, just as the loss of a human life triggers memories of other losses, resulting in a cascade of emotions flowing over grief.

“You must accept all of your feelings, and give yourself time to move on from anger, guilt and grief to a place of acceptance, forgiveness and compassion for both your loved one and yourself,” Dr. McDowell says.

As you move on, Dr. McDowell adds, you may be able to “illuminate the dark” for others who have experienced the same type of grief. Although April’s heart exploded with unimaginable grief when her son died last year, she is now trying to do just that. She is working on a book about Justin’s life and also trying to reach out in other ways, both to families who have lost a child and to the world at large, who may not realize that eating disorders, which are thought of mostly as issues affecting girls and women, not only affect, but also steal the lives of boys and men.

© Susan McQuillan

Sources:

Eating Recovery Center. https://www.eatingrecoverycenter.com/

Adele Ryan McDowell, Ph.D. http://adeleryanmcdowell.com/contact/

American Foundation for Suicide Prevention. Understanding Suicide.

Centers for Disease Control and Prevention. NCHS Brief No. 168: Mortality in the United States.

Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13:153-160.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102288/