Responding to Suicide Grief at Work Part I

This first article in a two-part series on suicide grief in the workplace describes the many ways workplaces are challenged in responding effectively to this type of tragedy.

Sally Spencer-Thomas and Jess Stohlmann-Rainey

Organizations are often ill-equipped and ill-informed to handle grieving employees. Allotted bereavement leave is determined by the kinship, defined by family structure, not closeness of relationship or needs defined by the bereaved employee. Most often this means: four days leave for the loss of a spouse, child, or parent; three days for the loss of a sibling, grandparent, grandchild, or parent-in-law; one day for the funeral of a sister-, brother-, son-, or daughter-in-law. Bereavement policies fail to account for the grief experiences of employees and that the return to work for many is often marked by distancing or demands rather than compassion. This is particularly true for the suicide bereaved, who experience the double silencing of workplaces ill-equipped to cope with grieving employees and stigma related to the type of loss.

A mother whose son died by suicide the day after he was discharged from his military service, shared this, 

“I had only been at my present position for 90 days, my probation period. I was given some money, they had collected. Other than that nothing. I was hurting very much. When the holidays came I put a candy cane, and a note asking for prayers in every one's mailbox. Nothing. No words, no notes, no nothing. One day I was walking down some steps, and I just wanted to let go of the railing [and fall to my death].  I talked to my supervisor and asked if I could just come in a little later on the Saturday mornings. I said I would stay late and be the last one to leave. She said to me, ‘I thought you were already over that.’  I wanted to ask her which one of her 3 sons she would ‘be over’ in less than 2 years.”

Figure 1

Disenfranchised grief is associated with a number of negative psychological outcomes, and often exacerbates painful feelings of grieving and prolongs the grief process. The incompatibility of these roles can leave the bereaved person balancing the roles, often in ways that look “troubled” or “inappropriate” to others in the workplace. As the dual process model suggests, grieving employees vacillate between grief work and restoration work. They are not always able to predict or control which role they are occupying at a given moment, so grief can enter the workplace in ways that surprise both the grieving employee and those around them. When the grieving employee loses a loved one to suicide, the silencing and stigma that may accompany that grief can make these surprising moments more uncomfortable and poignant for everyone involved. When grief work is stifled by stigma, the period of time during which these “disruptive” moments of grief surfacing in the workplace can be extended even further. Figure 1 (Carson J Spencer Foundation, 2015) illustrates the balancing act in which bereaved employees engage.

Type of death is also associated with disenfranchised grief, suicide being among the most likely types of death to cause disenfranchisement (Bento, 1994). With the compounded risk of the disenfranchised grief, the role of the workplace as a supportive environment is paramount for an employee bereaved by suicide. This need can be complicated for workplaces; employers must balance the role of productive employee with healing employee. Many characteristics of grieving are directly at odds with characteristics of productivity, including impaired decision making, lack of motivation, inability to concentrate, confusion, higher accident rates, and tardiness (Bento, 1994).

A teacher at the time of her teen-aged daughter’s suicide shared, 

“the principal called me into his office [the day after the suicide]. The two assistant principals were there seated glaring at me as I walked in. The principal told me that they did not want me to come to school the next day or when school began. I was very insulted. I argued and told them that I had shown up every day, I had done my job, and I needed to be in the classroom for the children. They just listened stone-faced. Finally, one of the assistance principals told me that no one could bear to look at me because the pain in my face and eyes was so terrible. That shocked me. I had no idea that my grief showed. (I guess I had not really looked in the mirror.) So then, I gave in, and I told them I would stay home for one week. They assured me they would get a professional retired teacher for my class and to stay home as long as I needed. I assured them I would be back in one week. I left school then and drove home very upset. After I got home, though, I suddenly felt a great relief, and I ended up staying home for seven weeks. It turned out that they knew best after all. After I returned to work, there were days I could not make it, so I called in sick. They never complained about me staying home too much. There were a few times I'd look at a little girl in class who reminded me of [my daughter], or something like that, and I'd break down. If I sent word to the office, they immediately sent a substitute teacher down so I could go home.”

Another employee shared how his son’s suicide affected his work performance, 

“I returned to work one week after [my son’s suicide]. I was under the illusion that I could suppress my pain and go on with my life as if nothing happened. The day I was placed on involuntary leave, I was facilitating a class of about 100 people. Someone interrupted me with an off topic question. Rather than gently deflect and move on, I went into an uncontrollable rage, comparing that person’s inane question to my pain over my son’s suicide. I was replaced in the classroom immediately. When I went to the corporate offices, they acknowledged my loss; however I was told to take a month off and see if I could return to full performance. Oddly, now that I've ‘cleaned up my act,’ there is a bit of empathy from management.”

Figure 2

Suicide postvention in the workplace to support a single employee affected by a suicide, which has occurred outside the work context, death can usually be accomplished through compassionate response and flexibility with work and expectations. This type of postvention can require much less investment from workplaces than the suicide death of an employee, client/customer, or other important person to the organization. Supporting a single employee comes with some simplicity because the rest of the workplace may not be impacted, and it is likely that the supervisor can occupy the singular role of “support person,” instead of needing to balance her/his own grief response with the wide range of impact a suicide loss will have on different members of the workplace. Figure 2 (Carson J Spencer Foundation, 2015) illustrates the priorities that must be balanced to maintain a healthy workplace.

Suicide postvention in the workplace focuses on mitigating negative outcomes for individuals and the workplace, and supporting the work community in a healing process (Carson J Spencer Foundation et al, 2013).  The goals of suicide postvention in the workplace is really not that different that other crisis responses (Carson J Spencer Foundation et al, 2013), i.e., to support people through the trauma and help restore functioning to a disrupted system (Suicide Prevention Resource Center, 2010). The process is about managing the inherent balance of needs and safety components that can sometimes be at odd with one another. On one hand workplaces acknowledge something really significant happened, while on the other hand leaders are pressured to get back to business as usual. On one hand grieving employees need to share stories to grief and honor a life that was lived, while on the other hand workplaces practice safe messaging seek to minimize glorification of the deceased and the divulgence of too many details about the death. On one hand, employees need information that is quick and accurate, while on the other hand, privacy and investigation concerns can slow and complicate the process.

A complicating issue for workplace suicide postvention is that getting fired, laid off, humiliated or disciplined at work can be a triggering event for some suicidal employees. When this occurs residual bitterness, anger and mistrust for leadership can have a profound effect on the intensity and duration of the employee’s response. 

One interviewee shared this story,

“My husband, an employee for 18 years, and supervisor for the last 15 and was let go from his position the day before he died by suicide. While this was the third suicide with the company, there was no crisis plan in place. Employees were notified when his death was posted on the lunchroom TV. Management chose not to attend the visitations or funeral in order to ‘keep the peace,’ but quite frankly I would have preferred to see them there. There was a lot of hostility because he was let go from his position as a supervisor, and when word of his death got out, there was more hostility from the people who worked with him in the plant.  Management let the dust settle over time with no comments.”

Few workplaces plan for a suicide by having access to a postvention guide like the one listed below, because too often the daunting nature of suicide throws people into reactive or avoidance mode. As a first step, we have managers reflect on the question, “What do you usually do when there has been a trauma or death in this workplace?” Usually there are already cultural norms and policies in place to address grief and trauma, and any deviation from this cultural standard is likely to cause confusion and additional hardship.

Case example: When an employee loses a family member to suicide

I am a pharmacist at a grocery store and had been there 8 years when my teenage son died by suicide. I knew all my customers by name and many of them knew my son. When word reached the store my store manager called everyone together to break the news. With tears streaming down his face he explained that my son was dead. Work was suspended, people were allowed to go home or take the time they needed to pull themselves together. For a grocery store this is huge as we are all about customer service in a community where the competition is fierce. By the afternoon I had cards, a gift basket and messages from so many of my workplace family. Many of the staff were able to take the day off to attend my son’s memorial and the store was generous in their contributions. Since my return to work, I have been given free rein to cry when I need to, hug when I need to and talk with others when I need to. My store management and fellow staff continue to be a source of support and comfort.

Conclusion: Be Prepared to Respond Instead of React

Like many workplace crises, managers are most effective when they are prepared to respond. In “A Manager’s Guide to Suicide Postvention in the Workplace: 10 Action Steps for Dealing with the Aftermath of Suicide” (Carson J Spencer Foundation et al, 2013) co-authors from the Carson J Spencer Foundation, Crisis Care Network, the National Action Alliance for Suicide Prevention, and the American Association of Suicidology highlight the strategies that will assist workplaces navigating this particular form of crisis response. The guide helps managers with crisis checklists, flowcharts and templates and is currently available as a free download PDF available to the public at www.WorkingMinds.org.

Mike Guthrie: My Journey to Find Meaning After Loss

By Emily Alvarez

Stories of lived experience can be used to fight the stigma of mental illness and suicide and to help people get involved in the movement. These journeys humanize the suicide prevention movement and help other people seek help. This series on lived experience is a great chance to highlight a loss survivor's story and the search for meaning after loss.

Every member of the Carson J Spencer Foundation has a reason why they do the work that they do. Our COO, Mike Guthrie, lost his brother to suicide in 2007. His journey to find meaning from his loss hasn't been quick or easy, but that is to be expected.

This is his story:

Steve Guthrie in the back bowls of Vail, CO

On March 20, 2007, I lost my brother Steve to suicide. He had just had his 50th birthday. We're a family of five children; I was second born, Steve third. We were almost four years apart in age, but as we grew up he and I were the closest of siblings. As adults, we were very close, vacationing together with our families, sharing the things closest to us. Steve was in love with nature--rivers, mountains, plants, animals, sky, everything. Being in the natural world with Steve was an exciting adventure. He was willing to try anything, and brought a sense of life and positive energy to everything he did. One of my recurring thoughts is that I've never known anyone who felt so alive and in touch with the energy of the universe.

I spoke for the family at the memorial service. He taught third grade in a small town in northern Idaho for 23 years, and people came from all over to the memorial service. I met former students from California, Michigan, New York, and many other states. There were 750 people at the memorial service,; many children and families. All were shocked and saddened, but when I spoke, I not only had to try to do justice to the wonderful spirit of the brother I loved, but also to acknowledge how, although not why, he died.

I can honestly say there has not been a day that has passed since Steve's death that I don't think of him. When I do any of the things that we loved doing together, he is on my shoulder. Skiing, favorite music, books, constellations, an unusual tree or rock formation makes me want to share with Steve. His three children are very dear to me, and every time I see or speak to one of them, I consciously honor his memoru.

I had worked in the mental health field for over 25 years when Steve died, but I had no idea what to do. No one I knew had talked about how to go through this experience. I was fortunate to work with a number of therapists, and they helped, mostly by just validating my feelings.

Steve's son was a student at a college 200 miles away. When I got the news, the first thing I had to do was drive there to find him, since I didn't want him to hear this from a phone call or random comment. I'll never forget that moment, and it was the beginning of my efforts to support his wife and children. I still don't know what to do or how to feel, but for me, I knew I had a duty to them, and to my family. That's what worked for me--reaching out to others. Everyone felt like the floor had caved in, and everyone needed a shoulder to cry on, or an ear to hear their memories, or someone to fix a meal or run an errand. I worked through my immediate grief by recognizing that I could be of service.

How is it that something so common, death by suicide, can be such a devastating mystery to those of us left behind? While we work to reduce deaths, we also need to share our experiences. We need to talk about this, so that others are not so alone in their suffering.

There are many things I do to honor Steve. Skiing in deep powder, really loud Lou Reed or Rolling Stones ( I still can't do opera, which he loved), touching one of the things he made from wood, smelling fresh rain in a high country forest. None of them, though, provide meaning. To me, his loss is still a mystery, without meaning. And that can't be changed. That's the choice he made, and it's not mine to understand. So I don't, and I won't.

What I choose is to recognize his choice, and to know that it did not have to end that way. I now work for a nonprofit in suicide prevention, and I have learned a great deal, like that there are options. I'm committed to having this conversation, over and over and over. Not to be oppressive or annoying, but to make sure that the community I inhabit recognizes that suicide and mental health are real, present, common, and treatable.

Family is very important, and my love for and connection with Steve's three wonderful children are a lifetime commitment. That's not changed with Steve's death, but has made it more of a constant pressence in my heart and mind. The work I do now does makes his kids proud, mine as well, and that's very meaningful to me. Really, though, what I think is that I strive to be the person he loved and respected. As a father, husband, brother, uncle, employee, citizen, all of that. I want to be alive and well, and to cherish the life, and family that I have. Since Steve was so, so full of life, that matters to me.

However it feels, you are not alone. There are people in your own community, maybe your own family, who have walked this difficult path before you. Don't do it alone. Even if people don't reach out to you, we're out here. If you raise your voice or your hand, we'll be there. 

The effects of a suicide loss are long-lasting and far-reaching. Many survivors look for ways to make meaning out of their loss and celebrate the life of their loved one. There are many wonderful organizations that provide life-saving suicide prevention programming. The Carson J Spencer Foundation elevates the conversation to make suicide prevention a health and safety priority. Through a variety of prevention programs, Carson J Spencer Foundation is changing the face of suicide loss. Whether you partner with our organization, or another, we encourage you to get involved. Giving a gift, in memory of a loved one lost, can help create the meaning that so many seek. For more information, please visit www.carsonjspencer.org.

Winners Announced in the Social Enterprise of the Year Competition

By Ginna Jones

"Be the change you wish to see in the world." - Mahatma Gandhi

The Carson J Spencer Foundation uses the FIRE Within program to empower high school youth to change the world they live in by launching student-led social enterprises that directly impact upstream causes of suicide among their peers. Targeting root causes of mental health distress such as bullying or peer pressure, students create and sell products or services designed to combat the problem and connect their classmates to help. In an end-of-year competition, a national panel of judges review students' work and names the most successful businesses as Social Enterprise of the Year. These classes will be presented with their prestigious award at the annual Shining Lights of Hope Gala on August 18, 2016.

George Washington

George Washington High School FIRE Class

George Washington High School, in Denver Public Schools, has been running FIRE Within for the past four years. This year, FIRE Within students in Eric Rodriguez's Psychology class worked to find a primary cause of mental health distress in their school and create a unique product to help reduce the problem. Student-led research showed that peers were experiencing extenuating pressure to balance competing responsibilities to school, family, friends, extracurricular activities, and relationships. They learned that many of their classmates coped with this stress by turning to exercise, through sports inside and outside of school. From this, an idea was born. H2OK is a simple water bottle with a twist. It contains an infuser that allows purchasers to add fruit or ice, giving it a more personalized feel. The name connects to their message that it's important to take care of ourselves physically and mentally, asking for help, focusing on overall health, and it's H2OK to take a break. Water bottles were sold with information on school counselors and the suicide prevention hotline, making it easier to talk about suicide prevention and connecting customers with recommended mental health resources.

"Our mission is to sell as many water bottles as we can to the entire school. We are trying to send out a message that life is worth living, and that each student at George Washington High School is worthy of happiness," an H2OK Student Entrepreneur said.

Students coordinated with administrators to sell H2OK water bottles in the North Lobby where students often hang out during lunch and after school. They incentivized purchases and return visits to their booth by providing free refills of water and iced tea, donated by a local business, and fresh fruit for infusers. Word caught on quickly and customers referred friends, siblings, parents, teachers, and coaches to purchase the product. Their tactics were a success and H2OK sold out of water bottles before the end of the year.

"What inspired me about H2OK was their willingness and dedication to working together as a team. There were times when working separately would have been easier, but they valued each other and wanted to hear everyone's ideas. If someone couldn't work the booth, at least two other students would volunteer. They did everything together," said Jenn Marshall, Sphere Education and FIRE Within Educator.

Dakota Ridge High

Dakota Ridge High School FIRE Within Class

Dakota Ridge began implementing the FIRE Within in Rachel Caliga's Entrepreneurship class in January of this year. The students had to work quickly to catch up with their competition as other FIRE classes had begun developing their suicide prevention initiatives last fall. With a drive to succeed, Dakota Ridge quickly pinpointed that their school community was overwhelmingly challenged by an academic pressure to succeed, at times compounded by struggles with depression and anxiety. After tragically losing a student at their school to suicide, these entrepreneurs knew their peers were at risk. In response, they designed their social enterprise, Operation Upstream, to spread messages of hope and increase access to suicide prevention resources. To combat sluggish sales, students had to think outside the box to find ways to raise funds and market their business. They organized an inter-school kickball tournament with Columbine High School, hosted a successful online fundraiser, facilitated carnival games during lunch hours, and solicited donations from local businesses.

"This group is very impressive, from the number of kids involved to the dedication and passion for the cause. They have built a company with a business plan that is sustainable and effective in achieving their goals. It was very clear to me that they really care for the well-being of their fellow students," said Lee Mulberry, Northern Star Consulting.

In less than a semester, Operation Upstream raised over $3,000 that they will put towards continuing their vital suicide prevention work. Elections were held for leadership positions and students look forward to expanding their legacy in the 2016-2017 school year.

"I am incredibly proud of these students and this program. This year showed me that not only is the FIRE within teaching our youth about suicide prevention, but it is empowering them with the tools, passion, and commitment to stand up for their communities and loved ones," Jamie Lowther, FIRE Within Educator, said.

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About the Carson J Spencer Foundation - Sustaining a Passion for Living

The Carson J Spencer Foundation (www.CarsonJSpencer.org) is a Colorado nonprofit, established in 2005.  We envision a world where leaders and communities are committed to sustaining a passion for living. We sustain a passion for living by:

• Delivering innovative and effective suicide prevention programs for working-aged people
• Empowering youth entrepreneurs to prevent suicide
• Supporting people bereaved by suicide

The Carson J Spencer Foundation is the proud 2013 recipient of the “Small Nonprofit of the Year” award from the Denver Metro Chamber of Commerce.

Patrick Drossel: My Journey to Find Meaning After Loss

by Emily Alvarez and Patrick Drossel

Stories of lived experience can be used to fight the stigma of mental illness and suicide and to help get people involved in the movement. These journeys humanize the suicide prevention movement and help other people seek help. This series on lived experience is a great chance to highlight a loss survivor's story and the search for meaning after a loss.

Patrick Drossel is a high school friend of a staff member at the Carson J Spencer Foundation. He lost his uncle three years ago and has been making meaning out of the loss ever since. The anniversary of his uncle's passing happened recently, and we wanted to share Patrick's story of finding meaning through loss.

Deven D. Drossel, BM3, US Navy

This is his story:

On April 19, 2013, I lost my uncle Deven to suicide. I did not really know my uncle that well, but everyone says that they miss his laugh. I grew up in California while he lived in Maine. I saw him a few times when I was in elementary school for his wedding, the birth of my first cousin, and my aunt's wedding. During one of his visits he brought me to my first Major League Baseball game. I can remember the game so vividly; the Boston Red Sox versus the Anaheim Angels. I remember that game the Red Sox won, and my uncle was thrilled. At that very moment I became a Red Sox fan.

It had been nearly a decade since I had seen him, but the summer of 2012 he came to California with my two cousins. This was the first time as an adult that I was able to see my uncle. I remember right off the bat when I saw him he said he wanted to have a beer with me and catch up, because he wouldn't know when the next time would be. It didn't matter that he had just gotten off a six hour plane ride, an hour in Los Angeles traffic, and was nearly 2:00 am his time, he wanted to talk with me. During this time, I connected with my uncle. We would stay up late to go swimming, cook, hanging out in the hot tub, and even toss a baseball around. But most importantly he told me stories that I have never heard before about my family. After that week and a half together, I felt as close as I have ever been to my uncle.

As I went back to college, I began to become busy, and my uncle would sporadically message me on Facebook to see how I was doing. Around this time, he had also enrolled in community college courses, so he would be able to get a college degree. On several occasions he asked for my help with some of his work and I was able to set aside some time from my chaotic schedule to help him. As baseball season began to roll around the corner, my friends and I always went to the home games, so I tried my best to keep my uncle up to date on Oregon's baseball team as well as chatting about the Red Sox.

Patrick and his uncle fishing

Friday, April 19, 2013, I was sitting at an Oregon baseball game when I got the call. I was in complete shock at the moment, but I put my emotions asisde and immediately called all of my family members to check on them. When I got home, I sat at my desk and tried  to piece everything together to see if this nightmare was actually happening. At that point, I quickly opened my text book and notes from a previous introduciton course to psychology. I turned to page 639. Major depression. I quickly scanned the section, my notes, and the internet for ways to avoid depressive symptoms. As soon as I had a list, I called my family. 

At this moment, I knew what I had to do. I had to become a psychologist to make sure families will not have to go through what mine had just gone through. 

I remember at that same moment that I wanted to dedicate my BA degree in memory of him. After a month has passed, he was laid to rest, but I was unable to attend his funeral. I finally felt like I was able to grieve, but how? How could I possible grieve and also memorialize my uncle?

Uncle Deven Fishing

With homework and projects piling up, it was difficult to give myself time to grieve. I had a project for my American Sign Language class where I had to sign a song, but interpret the meaning to yourself. I chose To Yesterday by BoyzIIMen. For me, this interpretation was saying goodbye to my unlce, and wishing that I could have been there at his funeral. In one of my counseling psychology classes, I learned about resiliency. From that lesson and reflection, I realized the two main resilient activities that I absolutely loved were baseball and fishing.

As a student, I was able to go to every home baseball game for free. My friends and I tried going to as many home baseball games as possible. The only thing missing from the games was a roaring crowd. Our solution? Vuvuzelas. With time and eventual acceptance from crown management, my friends and I created a cheer group, the University of Oregon Zela Crew. The baseball team probably thought we were just a group of crazy college kids that loved baseball, but for me, this team helped my cope with the loss of my uncle. It also happened that in 2013, the Boston Red Sox, his favorite team, won the World Series.

Patrick in his stole at graduation

As time started to move along, the heart ache began to dissipate. At times it is still difficult to deal with his loss, but the memories we had together will be held close for the rest of my life. He still remains to be my drive. Soon after his death, I became interested in the traumas of war. I knew he was a BM3 in the Navy earlier in his life. I learned that on average of 22 veterans die by suicide every day.

Unfortunately, my uncle happened to be a part of this statistic. This drive of becoming a psychologist soon became a drive to be a psychologust for the US Navy. I want to abolish this statistic, or try my best to put a dent in it.

When I graduated in the summer of 2015 from the University of Oregon, stoles were optional, so I created my own. One side of the stole was yellow for suicide prevention, and the other side was teal for PTSD awareness.

Currently, I am volunteering for a research lab studying war and memory while I apply for Maters and PsyD programs in the fall. I  know my uncle would be proud of my accomplishments and would be delighted that I am doing this with him in mind. He continues to be my drive every day. I have yet to visit his grave, but I don't feel like the time is right for me. I haven't seen my unlce since the summer of 2012, and I want the first time when I drive up to the Riverside National Cemetary to be a special occasion.

Patrick fishing on the third anniversary

I vision myself saluting him in my full dress Naval officer uniform as a psychologist. At that point, I will feel like I have finally made it.

In the meantime, I like to memorialize my uncle by going fishing on the anniversary of his death. No matter how busy I am, I will try to find time to go fishing. To me, fishing is very theraputic. Where like the fishing line, I let go of all my stresses in life and have them flow down the river. This was a time to relax and reflect all the great memories we had shared.

To those who have recently lost a loved one to suicide, do not place the blame on yourself or others. Memorialize the person you love, and celebrat their life. Forget any negatives, embrace the positives and great memories that you have shared together. Hold those memories close to your heart and never let go. To memorialize them, I suggest picking a safe activity that reminds you of them, and do that activity. You can either do it as a group, or pick something that you can do solo to memorialize. It does not matter how big or small the activity is a long as you enjoy it and memorialize the loved one that you have lost. After this experience I am sure to let those that are close to me that that I love them. 

Rest in peace, Uncle Deven, you will continue to be loved and missed.

Deven D. Drossel

BM3 US Navy

September 30, 1694 - April 19, 2013

Gone But Not Forgotten

The effects of a suicide loss are long-lasting and far-reaching. Many survivors look for ways to make meaning out of their loss and celebrate the life of their loved one. There are many wonderful organizations that provide life-saving suicide prevention programming. The Carson J Spencer Foundation elevates the conversation to make suicide prevention a health and safety priority. Through a variety of prevention programs, the Carson J Spencer Foundation is changing the face of suicide loss. Whether you partner with our organization, or another, we encourage you to get involved. Giving a gift, in memory of a loved one lost, can help create the meaning that so many seek. For more information, please visit www.carsonjspencer.org.

Words Make Worlds: Language and the Culture of Mental Health in the Workplace

Republished with Permission from Insurance Thought Leadership
By Sally Spencer-Thomas and Donna Hardaker

Part II: The Words about Suicide

[Part I of this series focused on why language matters in mental health advocacy and suicide prevention in the workplace. This article explores wording related to suicide that we want to see change and why. Part III will look at wording related to mental health.]

"suicidal" -- "suicide attempter" -- "he chose to die by suicide"

Photo from pexels.com

Language evolves as understanding evolves. We seek to draw attention to word and phrase choice about suicide and mental health as a means of articulating current understanding and intentionally pushing further evolution.

We are often asked: What is the best way to talk about suicide?

"Died by suicide"

Much of the language related to suicide death comes from a stigmatizing history. The term "committed suicide" originated when suicide was thought of as a sin or a crime, instead of as a fatal outcome of a set of thoughts, often a result of a mental health condition. It is still the most common way for people to describe a death by suicide in the general public, the media and even in the mental health sector. We can ask ourselves: does someone die by committing a car accident? By committing cancer?

Terms commonly used to describe whether a person has died or not: "successful" suicide or "unsuccessful" attempt. The use of the word successful is highly insensitive to the tragedy of a death by suicide. Similarly, we hear the term "completed suicide" to refer to a death by suicide. In North American culture we place a positive value on success and on completion, as with goals, projects, education, etc., so there is an inference that there is a good inside of the suicide death when we refer to it as successful or complete.

When talking about suicide in general, the suggested practice is to test language by substituting the word "cancer" for the word "suicide." If it sounds odd, chances are the phrase has come from a stigmatizing origin. For example, we wouldn't say "the cancer was successful," we would say "a person died from cancer." Thus "dies by suicide" is the best option we have to describe suicide death.

This also informs us as we are speaking that suicide is a cause of death, which encourages us to look at it with the same lens we look at cancer, car accidents, and other causes of death. We can seek to apply a public health advocacy approach, rather than a blame the victim approach which is a result of the use of archaic language.

"A person who is thinking of dying suicide"

When we label people, and group them according to an identifier, we are seeking to simplify who they are. It is a short-cut language strategy that also short-cuts understanding and connection. In suicide, it is often seen the label: "a suicidal person", "he is suicidal". Using our swap "suicide" for "cancer" rule: Are you cancerous or are you a person who has cancer? We prefer: "a person who experiences suicidal thoughts". "a person who is thinking of dying by suicide".

The fallacies of choice and manipulation

For most who die by suicide, we believe their choice would have been to live if they could have found a way out of the mindset of dying. Unbearable psychological pain may be accompanied by very strong internal commands to die. This experience is not the usual type of rational choice in the way we commonly think about choice. People often say "a person chose to die by suicide". Inside this thinking, there is a sense of an absolving anyone other than the person who died of any responsibility, which we understand. It is very difficult to grasp that a person has died by suicide, and we often seek solace in using language that infers that the person acted completely freely. We wish to undo this type of phrasing that infers that true "choice" is part of the picture. We prefer that people do not use the word "choice" when talking about a death by suicide.

Also in the language of suicide, we find phrases that infer that a person who has made a suicide attempt is manipulative, and is just "seeking attention." The phrase "suicide gesture" has an inference that intent is not genuine. We prefer: "an action with suicide intent."

"Precipitating Events"

When a person dies by suicide and we wish to talk about what lead up to their death, we often talk about "triggering events." The word "trigger" is problematic because of its strong connection to firearm use. Also, by calling something a triggering event, the phrase denies an opportunity for people to have mastery over the impact of the event. It is preferable to use a more objective term to describe prior events and challenges. We prefer: "precipitating events."

Clarity around "survivor"

The term "suicide survivor" is confusing. Depending on how it is used, this phrase may mean a suicide loss survivor (a loved one left behind when a person dies by suicide). At other times, it means suicide attempt survivor (the person who has made an action with suicide intent, and survived the action). Thus, the preferred terminology for people who are left behind: "a person who is bereaved by suicide," or "a person who is surviving a suicide loss". People who attempt suicide, but do not die can be referred to as: "a person who attempted suicide and survived" to help with clarity. In addition, the field of suicide prevention also seeks the expertise of people who have lived through a suicide crisis and did not have an attempt, and sometimes these folks are included under the umbrella of "people with lived experience of suicide."

In conclusion, "messaging matters" in suicide prevention and suicide grief support. For more best practices, review "The Framework for Successful Messaging by the National Action Alliance for Suicide Prevention: http://suicidepreventionmessaging.actionallianceforsuicideprevention.org/.

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SALLY SPENCER-THOMAS: As a clinical psychologist, mental health advocate, faculty member, and survivor of her brother's suicide, Dr. Sally Spencer-Thomas sees the issues of suicide prevention from many perspectives. Currently, she holds leadership positions for the Carson J Spencer Foundation, the National Action Alliance for Suicide Prevention, and the American Association for Suicidology.

DONNA HARDAKER: Donna is an internationally recognized industry expert in the emerging field of workplace mental health. She is an award-winning curriculum developer, advocate, public speaker, writer, and advisor, who has leveraged her personal experience of mental health challenges and their impact on her employment history into a significant body of work. She is the Director of Wellness Works, a workplace mental health training program for Mental Health America of California that has been evaluated as highly effective in stigma reduction with lasting behavior and culture change. Donna is from Toronto, Canada, but now lives in Sacramento, where she greatly enjoys the California sunshine.

Trigger Warning: Means Restriction, Suicide, and Gun Safety

By Thomas Wallingford and Jess Stohlmann-Rainey

In the United States, more than 60% of people who die from guns die by suicide (Center for Disease Control).

In Colorado, more than three-quarters of all firearm deaths during 2005-2012 were suicides. Of those suicide deaths by firearm, most are among males (84%) and the white, non-Hispanic racial/ethnic group (88%) (Colorado Department of Public Health & Environment).

For youth under the age of 20 years killed by firearms in Colorado, almost 50% were suicides and 41% were homicides (Colorado Department of Public Health & Environment).

Proponents of gun safety have developed a list called the 10 Commandments of Gun Safety, which include guidelines like, "always point the muzzle in a safe direction" and "don't mix alcohol or drugs with shooting." Because of the connection between firearms and suicide, prevention advocates have worked with gun safety proponents to suggest an 11th commandment, "Consider off-site storage if a family member may be suicidal."

There are obvious benefits to adding this commandment, but putting it into actual practice can present some challenges. For gun owners in distress, finding a way to store firearms with someone else requires a difficult conversation about their mental health for which they may not be prepared. For support people, asking a loved one who is struggling to give up their weapons can be intimidating.

Thomas Wallingford lives with schizoaffective disorder, which causes him to experience intermittent suicidal intensity. Thomas and Jess Stohlmann-Rainey have been close friends since college and use each other for peer support as people who live with mental health conditions. In order to demonstrate how this commandment can be put into practice, we would like to share our personal accounts of means restrictions.

Jess:

Jess and Thomas

I remember the first time I asked someone about their suicidal thoughts with pretty vivid intensity. I worked on a sexual assault advocacy hotline, and was on the phone with a client who was really struggling. My palms got so sweaty I was afraid I would drop the phone. Because most of my jobs have required that I talk about and ask people about suicidal intensity pretty regularly, I have gotten a lot more comfortable with asking the question. Asking Thomas to let me hold onto his firearms while he was in crisis was an easy decision the first time, but caused me the same level of anxiety. I called another friend to practice what I was going to say. Fortunately, because Thomas and I talk about our mental health all the time, any weirdness that might have happened in a new mental health discussion was out of the way. I remember saying "I have to ask you this because I love you and because I would never forgive myself if I didn't...would it be okay if I hold onto your guns for a little while?" 

When Thomas agreed, we ended up making jokes about the whole situation because it seems so surreal. It is entirely possible that I am more uncomfortable with guns than anyone else in the world. Thomas gave me this duffel bag full of firearms, and we cracked some jokes about how weirdly I was holding the bag (it was pretty weird). I continued being extraordinarily awkward riding in the elevator up to my apartment, feeling certain that everyone in there knew I was holding a bag of guns and was freaking out. They didn't, and I got them safely into a secure area in my home without scaring anyone but myself.

The entire time I had firearms in my home, I was acutely aware of their presence. As much as I wanted them out of my home, I was nervous that Thomas would ask me to return them before it seemed like it was safe. I believe really strongly that people living with mental health conditions should have the same rights as people who don't, so if Thomas was adamant about me returning his firearms, I would have a really difficult time refusing. I decided that I would ask him to make another safety plan if that happened.

Thomas ended up leaving his firearms with me for several months, until his mental health was significantly improved. When he wanted his firearms returned, he spent a lot of time explaining why he felt well enough to have them again. Returning them was relieving both because I didn't have them in my home anymore, and because Thomas was in such a better place with his mental health. He explained his safety plans and his current mental state, and made me feel confident that his suicidal intensity had dissipated.

After the first experience, the whole process has become much simpler. Thomas has since asked me to hold onto his guns, and I have asked him. The conversation is short and can even happen over a text message - "hey, can you hold onto my guns while I do a treatment program?" or "it sounds like you are thinking about suicide again, can I hold onto your guns?" I am still incredibly awkward about guns in general, but asking about means restriction feels pretty easy now.  

Thomas:

Thomas with one of his guns

Handing guns off to your support person is somewhat distressing. You're constantly second guessing yourself, wondering "Am I really at this point? Shouldn't I be well enough to keep them?" For some gun owners, particularly those concerned with home security, I'm sure it would be an added challenge, weighing the possible dangers from outside with the possible dangers from within. After the initial shock wears off, and you're considering your decision from a more distant vantage point, it's apparent that what you've done is the most rational decision regarding your safety.

Realizing when you've hit the point where you need to reach out to your support system is very tricky. There's no black and white to it, no hard line; it's a huge gradient.

How I know to reach out to my friends is when I'm ruminating on suicide more often than not. Specifically, it's when my ruminations on suicide go from conceptual thoughts to considering it as an option. To ensure I take the preventative step of giving my guns to my support people, I don't wait until I consider it as my only option; once it becomes any option it's time for me to take my guns elsewhere. It's better to be too early than too late.

Asking someone to take your guns is a multi-step process that begins before any suicidal thoughts occur. Talk to a friend, or a few friends, that can offer safety and support and tell them about your personal concerns regarding suicidal thoughts or behaviors. Ask them if they are okay with you relying on them if you begin feeling suicidal.

Actually asking someone to take your guns is difficult. It's the same feeling as having someone come over to take your guns. You ask yourself, "Am I really at this point?" you might stigmatize yourself, asking if you're really that "crazy," and you may even feel childish, like you can't take care of yourself. The fact that an individual struggles with suicidal thoughts from time to time says nothing about how capable they are as a person. Suicidal thoughts are an unfortunate part of a chronic mental health condition for me, but prevention is a necessary step in managing it.

Just like giving them up, there's no hard and fast rule about when to ask for them back. For me, it's when I've had no intrusive thoughts or ruminations about suicide for over a week, maybe two. Having one good day isn't enough to know that I'm safe, but having several in a row lets me know that there is a pattern to my thinking and that the pattern has improved. But just as with knowing when to give up your guns, knowing when you can safely take them back is very personal. The best advice I can give is to ask for them back when you've seen a trend. If you're a gun owner who has them in the house for personal protection, know that sometimes having them out of the house is just as important.

You might worry that your support person won't think you're out of the woods yet, even if you think you are. If you and your support person disagree, just know that they're looking out for you. If you've been isolating, they may not have seen your progress. Simply avoid isolating and allow them to see that your suicidal thinking has run its course for the time being.

For the most part, being honest about how you're feeling and what you've been experiencing is the most important piece of asking for your guns. A pivotal piece comes before talking to anyone else. Asking "Am I okay?" is the most important part of the process.

 Means restriction can feel complex and overwhelming, but maintaining open and honest communication and focusing on safety makes the process easier. Going through it has made our relationship stronger and closer. We know that we have someone to rely on who understand us no matter what.

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Thomas Wallingford is a Denver-area writer and poet. He is a graduate of the University of Northern Colorado and has been a featured speaker and writer on topics ranging from social justice and mental health to fiction and poetry. Thomas is passionate about understanding the world and the people in it, dedicating his work and free time to science and psychology. Thomas integrates his lived experience with mental health challenges to his work as an author and advocate. His creative work illuminates parts of life from which most people look away, challenging readers to explore the least understood parts of the world and their human experience.

Jess Stohlmann-Rainey, MA, is the Senior Program Director at the Carson J Spencer Foundation. She has spent her career in violence prevention, currently leading innovative programming that elevates the conversation to make suicide prevention a health and safety priority. Jess has presented and trained nationally and internationally about suicide and violence prevention, diversity, and leadership, and is a contributing author to Postvention in Action, a currently unreleased suicide prevention anthology. As a suicide attempt survivor, survivor of loss, and person living with a mental health condition, Jess integrates her lived experience into her work in advocacy, research, training, and program development.

Rage Rage Against the Dying of the Light

By Heidi Kathryn

I was 10 when the first fleeting thoughts of suicide flashed like white lights through my mind. I knew at a young age that my brain worked differently than others. Freshman year of high school was the beginning of a series of traumatic events that impacted my ability to regulate my emotions and sustain healthy relationships. I found myself in an extremely unhealthy relationship with a much older man that resulted in a terminated pregnancy and my first suicide attempt. I was hospitalized for a week, then was forced to move out of the city and into my father's house in a rural Colorado town.

Life in the small town wasn't much better. I went to class, made some friends, played sports, and endured three years of physical abuse from my father. The dog and I got the worst of it. Home was never safe for me. I lived in a constant state of fear and apprehension, wondering if he'd be in a bad mood when he came home. It wasn't until years later that I could put a term to that feeling. That feeling was anxiety, and I would learn to live with it, always.

Things never really seemed to get better. I went through the motions, survived high school and got the hell out of that tiny town. College would only exacerbate the anxiety and depression. I turned to self-harm, starvation, and drug use to feel in control or nothing at all. Suicide was always on my mind. I would go weeks on benders, without sleeping or eating. I would frequently show up to class agitated, sometimes even in tears. My professors would send me home and tell me to sleep. I got to the point where I didn't even care to cover my scars, new or old. I woke up wanting to die, and if I was able to sleep, I would dream of dying. My social scene was a series of abusive, drug-addled, violent relationships; I gravitated towards men who would hurt me. I circled the drain until graduation and then moved on again.

Photo by Aleksandar Radovanovic

As I've learned the hard way, multiple times now, changing my address never actually solved any problems. My anger and self-hatred festered the longer it went untreated. I became fearful of myself. I became fearful of others. Generalized anxiety turned into anorexia which turned into full-blown obsessive-compulsive disorder. I was so scared of bugs that I couldn't sleep through the night. My perseveration around germs was out of control such that touching a doorknob with my bare hands would send me into panic. Crying at my desk became a common occurrence. I struggled to find a therapist who could really help. Or even one who could understand. And in October 2014, I attempted suicide again. This time, it almost worked.

My colleagues and I agreed that treatment was the best option for me. The people I work with and our connections outside our organization worked tirelessly to get me into a program. These are friends and colleagues who know this field, and it still took a week. When we finally found a place for me, I had convinced myself that I didn't need anything intensive. I had planned on doing a program that was three days a week. After my intake, the provider suggested that I would need something more intensive, with more structure, to get me through this crisis. I remember my friend telling me "if you broke your arm and you needed surgery, you'd have the surgery. This is no different."

I entered the partial hospitalization program, which was followed by their intensive 12 week Intensive Outpatient Program that is rooted in Dialectical Behavior Therapy. The first day of partial hospitalization was the hardest. I remember sitting across from my psychiatrist while he did my intake. We talked about symptoms, sadness, numbness, and anger. We talked about physical and emotional abuse. I admired his socks, and he read me off the criteria for my current diagnosis.

"Tell me if any of these things sound like you," he said. "Extreme reactions--including panic, depression, rage, or frantic actions--to abandonment, whether real or perceived...A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)...Distorted and unstable self-image or sense of self, which can result in sudden changed in feelings, opinions, values, or plans and goals for the future (such as school or career choice)..."

My stomach turned as he read off the diagnostic criteria.

Photo by Max Greenwood

"Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating...Recurring suicidal behaviors...Highly changeable moods, feelings of emptiness or boredom...Inappropriate, intense anger or problems controlling anger?"

The rage he kept referring to seared through me. I knew exactly what he was referencing. I planted my foot on the ground and slammed myself into the wall behind me so hard that my head bounced off the concrete.

"I'm not fucking borderline! That's not what's wrong with me! You're wrong!" I cried to him. Everything in me had wished that I would have just died.

Borderline Personality Disorder is a highly lethal, highly stigmatized mental health condition. The most recent data I've read say that 10% of people diagnosed with BPD die by suicide. The Diagnostic and Statistical Manual (DSM) lists BPD under the umbrella of personality disorders. It is the result of years of trauma. And it makes clinicians' skin crawl. From what I've noticed, the general public doesn't really seem to know much about it. But the things I've heard from mental health professionals about people, specifically women, with BPD are scathing and hateful. We are a clinician's worst nightmare. We are not the "right" kind of mentally ill.

This frustrating reality is what has prompted me to share my story with the world. I am a suicide preventionist who lives with chronic suicidal intensity and a diagnosis of Borderline Personality Disorder. I am deserving of hope and help. I am difficult, but that doesn't warrant being brushed off. Thank goodness my workplace and career choices have allowed my the opportunity to really learn how to advocate for my own mental health treatment. I am angry for anyone else with a history like mine, who have been brushed off as manipulative or difficult, who have been told their chances of success and recovery are nil, that they'd never be able to hold down a job, or that they'll never make good parents and should take their birth control and medication and shut the hell up. I hurt for folks who are so sick that leaving the house is more miserable than staying home inside their head, trapped in their thoughts, and folks who show up to an emergency room or clinic scared that they'll hurt themselves, and get dismissed because of a condition the world gave to them.

Heidi's dogs, Ivan & Violet

It is an injustice that the very people we are supposed to turn to for help are consistently blaming us for our condition and either flat out refusing to help us with our treatment, or giving us little attention when we show up for our appointments. It is an injustice that mental health professionals can victim-blame their clients. It is an injustice that anyone can list "trauma-informed" on their resume or website while still insisting that people with BPD are untreatable.

I have spent the last two years of my life reading, searching, and educating myself on my mental health condition. I see a therapist every week, take my meds every day, and visit the psychiatrist every two months. Instead of self-harm, I use tattoos to cope. When I feel an identity crisis coming on, I change the color of my hair. I use a combination of traditional and non-traditional methods to help me stay alive, like comedy and the company of my dogs. I have stayed relatively quiet about my experience with this diagnosis.

Not anymore. I will not remain silent while others are suffering. I will be loud enough so that others with similar experiences and diagnoses don't have to feel ashamed. The thing about activism is that it's so invigorating that is has given me a reason to keep living when my brain is telling me not to.

This is my suicide prevention.

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Heidi Kathryn is the Community Outreach Coordinator for the Carson J Spencer Foundation. Her passion for violence prevention has moved her into the field of upstream, innovative suicide prevention work. She provides outreach and support to the community as well as delivering mental health and violence prevention programming in workplaces, schools, and local public agencies. She is currently pursuing her MPH from Capella Unversity and looks forward to continuing her career in violence prevention and community engagement and collaboration.