Wednesday, December 28, 2011

A Simple Gift: Reaching Out and Renewing Hope


By Sally Spencer-Thomas

After my brother died by suicide in 2004, my workplace gave me the most amazing gift – the gift of their support. As many of them reached out to me, their kindness made all the difference in my ability to cope with this devastating loss.

First, there was Jerene, my direct supervisor. Just two days after my brother’s death, Jerene called me up, “Sally where are you? I am coming over to give you something.”

She drove from our workplace up to my parents’ home and delivered a huge vat of chicken soup. During a time when my family could barely choke anything down, that soup sustained us.

Then there was Tom, my Vice President. On the day of the memorial service, Tom joined many of my co-workers at the church. After the service was over, he found me and gently cupped my face in his hands to express his sympathy. This tender gesture was so heartfelt and kind; I will never forget it.

Finally, my bereavement leave ended, and I found myself facing the reality that I needed to return to work and some level of functioning. When I opened the door to my office on my first day back, my desk was covered with cards, flowers and well-wishes. From co-workers I knew well, and from folks I didn’t know at all. I instantly knew that the support I was going to get was going to carry me through this very difficult part of my life.

Belonging
Humans are hardwired to be in relationship with others. For some these are vast connections and broad social networks, and for others just a few intimate bonds are all they need. Workplaces that are mentally healthy cultivate a sense of belonging. Work teams and social groups can sometimes evolve into friendships that last a lifetime. Belonging fosters a sense of trust and interdependency that can help distressed workers find hope during tough times. When workmates pull together around difficult assignments, the encouragement they give one another can be the protective factor that decreases the impact of high levels of stress. For these reasons, workplaces that foster genuine belonging will find they have more mentally resilient employees.

A Little Goes a Long Way
While we can all think of some people that are constant drains in relationships because their needs are so great, most people do not need much. A little caring usually goes a long way. For example, in one study, hospitals sent caring letters to people who had recently been discharged after a serious suicide attempt. The letters just said something to the effect of, “We’re so glad you came in for treatment. Please, call us if we can help in any way.” Each letter was personalized to a small degree and signed by the attending care provider. The research found that the patients who received the caring letters were significantly less likely to have a subsequent suicide attempt than those who didn’t get the letters. If that wasn’t enough, the study was replicated using computer generated postcards – no personalization whatsoever. The same outcome resulted. If a computer generated postcard can have this level of impact, think about what is possible when people who know each other reach out and say, “I see that you have been looking down lately. I am here for you.”

Reaching the Unreachable
Another known fact is that people who have multiple risks for suicide are also sometimes the least likely to seek help on their own. Because of this, caring work communities need to be intentional in reaching the “unreachable.”

Mother Teresa was known for helping those that no one else would. In a story she wrote in her book, In the Heart of the World, she talks about finding an elderly man who had been ignored by everyone and whose home was in complete disarray.

She told him, "Please, let me clean your house, wash your clothes, and make your bed." He answered, "I'm okay like this. Let it be."

She persisted and he finally agreed. While she was cleaning his house, she discovered a beautiful lamp, covered with dust.

She asked him, "Don't you light your lamp? Don't you ever use it?"

He answered, "No. No one comes to see me. I have no need to light it. Who would I light it for?"

She asked, "Would you light it every night if the sisters came?"

He replied, "Of course."

From that day on the sisters committed themselves to visiting him every evening. They cleaned the lamp and lit it every evening.

Two years went by and Mother Teresa had completely forgotten that man when she received a message from him: "Tell my friend that the light she lit in my life continues to shine still."

Re-Gifting
One of the great things about the gift of reaching out is that we can re-gift it and people don’t think it’s tacky. It turns out the idea of “paying it forward” is both a gift to the receiver and a gift to the giver. When people who have been helped through a difficult time are able to help another, they often find meaning in their earlier struggle and value the wisdom gained.

This notion of “reciprocity” is one of the cornerstones in what make programs like Alcoholics Anonymous work. When people successfully go through the 12-steps of the program and maintain their sobriety, they can become sponsors and support others who are just beginning. The work of being a sponsor helps many maintain sobriety because it strengthens positive self-regard. Furthermore, sponsors find that being there for someone else makes them hold themselves accountable to being a worthy role model.

If people who are resistant to seeking help see an opportunity to pay it forward by mentoring another down the road, they often become more inclined to receive the gift of help. Peer support and mentoring programs offer these opportunities at worksites, but other opportunities can exist within communities.

In summary, reaching out is a great gift – one size fits all, and it’s easy to exchange.

For more information on suicide prevention, intervention or postvention training visit
www.WorkingMinds.org or contact Sally@CarsonJSpencer.org.

About the Author
As a psychologist and the survivor of her brother’s suicide, Dr. Sally Spencer-Thomas addresses the issue of suicide prevention, intervention and postvention from many angles. Currently she is the Executive Director for the Carson J Spencer Foundation (www.CarsonJSpencer.org), a Colorado-based (USA) nonprofit that is dedicated to “sustaining a passion for life” through suicide prevention, social enterprise and support for emerging leaders.” In 2009, the Carson J Spencer Foundation launched the Working Minds Program (
www.WorkingMinds.org), a comprehensive suicide prevention initiative for workplaces. As a professional speaker, she frequently presents keynotes and trainings for workplaces, campuses, and conferences around the world. In addition, she is the Executive Secretary for the National Action Alliance for Suicide Prevention, the public-private partnership advancing the Surgeon General’s National Strategy for Suicide Prevention. Finally, she is the Division Chair for Survivors of Suicide Loss for the American Association of Suicidology. 

Wednesday, December 21, 2011

Tensions in Postvention: An International Dialogue Part I

By Sally Spencer-Thomas

In the aftermath of a suicide, several needs are evident —psychological first aid for those most directly affected, help for communities as they return to a level of functioning, and surveillance for vulnerable individuals who might be harmed by contagion. The strategies to achieve meeting these needs sometimes come into conflict with one another and create tension in our postvention efforts. Well-meaning and well-informed people can find themselves firmly standing on one side or another of these points of potential disagreement, complicating an already difficult process.

In September this year, I had the honor of facilitating an international discussion on the “Tensions in Postvention” at the International Association of Suicide Prevention’s (IASP) World Congress in Beijing. About two dozen people gathered to join some of the top suicidologists from around the globe as we explored the challenges of supporting individuals, families and communities in the aftermath of a suicide. Among the invited participants were:


· Karl Andriessen, M.Suicidology, (BELGIUM), Coordinator of the Suicide Prevention Program of the Flemish Mental Health Centres, and Co-Chair of the IASP Taskforce on Suicide Bereavement and Postvention. He is a tireless advocate for the needs of people bereaved by suicide.
· Prof. Onja Grad, PhD, (SLOVENIA), clinical psychologist who has worked with survivors on a daily basis for the past 22 years — with individuals, families, groups. She is also a teacher at the University of Ljubljana School of Medicine.
· Myfanwy Maple, PhD, BSW (Honours Degree), (AUSTRALIA), senior Lecturer, Social Work Course Coordinator, School of Health. He is a social work academic and researcher in suicide bereavement over the past decade, particularly examining the experiences of individual family members experience of loss.
· Sandra Palmer, Ph.D. (NEW ZEALAND), a registered psychologist and Clinical Manager Community Postvention Response Service, and provides support to communities experiencing suicide clusters or contagion. She continually faces the challenge of balancing the need for communities and families to honor the loss of loved ones with safe postvention practices to manage contagion to prevent further losses in the community.
· John Peters, M.Suicidology (UNITED KINGDOM), lost his son to suicide 19 years ago and has for many years been a volunteer with Survivors of Bereavement by Suicide including staffing their Helpline each week and running peer-led support groups and an annual support day.
· Diana Sands, PhD, (AUSTRALIA), Director, Bereaved by Suicide Service; has worked with families bereaved by suicide for over twenty years, produced a film and wrote a book for children bereaved by suicide. She will speak to the complex and sensitive issues regarding how to talk with children bereaved by suicide.

During this session we discussed the following questions:

1) How can we balance the need to prevent contagion with the need to honor loss?
2) How do we balance getting a familiar sense of normalcy with the acknowledgement of significance to a community that has been deeply affected by a suicide loss?
3) Do we tell children about suicide or not? When do we tell them? How much information?
4) What services do we provide – lay led, professionally facilitated or some combination? Knowing that the research indicates the benefits of peer led efforts, how do we manage quality control and sustainability?
5) How do we safely involve survivors or suicide loss and attempts in research? What are the best protocols for this?

In this column, I will review the discussion of the first two questions, and in the next issue of Newslink I will review the discussion of the last three questions.

How can we balance the need to prevent contagion with the need to honor loss? 


As we opened the discussion many participants shared examples of how communities have navigated the balance between what family and close friends want and what is safe for the community. Sandra Palmer talked about how t-shirts printed with pictures of lost loved ones are commonly seen at funerals and memorialization events. She went on to describe how families when told about the potential risk will also print a hotline number or other resource on the t-shirt. I talked about how candle lighting ceremonies are common and how we can help communities make these events safer by coaching the event planners on safe messaging and surrounding the attendees with helpful resources. Jill Fisher of Australia talked about framing a memorial event as a remembrance event celebrating life rather than over-emphasizing the circumstances of a death.

Sandra Palmer: “What we are getting to is about balance.”

Jill Fisher: “We try to do a number of activities to meet a number of needs of the bereaved.”

Onja Grad: “[The response] has to be right away.”

Diane Sands: “Schools are much more careful. Families are more thoughtful and respectful to the community. We can rely on folk to be more thoughtful.”

As in many provocative discussions attendees raised additional questions:

· How can we be proactive in our efforts with families and communities so they understand the risks?
· Knowing that it is never anyone’s intention to cause additional harm, how do we explain to families that there is a risk in doing things the way they planned?
· Many families, including my own, have a huge desire to do prevention work right away, and yet without proper time to grieve and heal sometimes these efforts crash and burn, causing additional hardship. How can we counsel people to heal first and engage in prevention activities later?
· How do we support people in bereavement when we are not of the grieving family’s culture?
· How do we promote young people’s safety while giving them the space to grieve in their own way, which often includes very public expressions through social media? For instance, youth sometimes post on their deceased friend’s Facebook page. Sometimes the outpouring reflects their grief at the loss like a public shrine of flowers and stuffed animials might. Others post comments like “you are now in a better place,” thereby romanticizing the death and minimizing the tragedy.

The general consensus of the group was that both honoring loss and preventing contagion are possible. With outreach to new survivors and supportive instruction about preventing contagion, we can allow a safe space for the bereaved to mourn and direct the grief energy so that risk factors for contagion are minimized.

[To watch this Part I of the discussion:
http://www.youtube.com/watch?v=0kIoXoCvrz4 ]

How do we balance getting a familiar sense of normalcy with the acknowledgement of significance to a community that has been deeply affected by a suicide loss? 
This question revolves around a community response to suicide. We noted that returning to a previous routine can be grounding for many after a trauma; it offers structure and a sense of familiarity. Nevertheless, moving too quickly or too completely to “business as usual” can make those closest to the loss feel discounted.

We also acknowledged that in larger systems and communities there will often be many people who are not affected at all by the death, and if we go in “all guns blazing” we can do harm.

Many cited George Bonanno’s work (Bonanno, 2004) on resiliency after trauma and emphasized the potential strength of the human spirit and the power of communities pulling together after a loss like suicide. The key to finding the right balance revolved around framing the interventions as choices with the understanding that different survivors need different things at different points in their grief journey. Jill Fisher called her approach an invitation of the “lightest touch” so that what we offer won’t interfere with the natural resilience that exists.

As Jill noted, “After a suicide you find police, criminal investigators, medical rescue professionals, coroners — up to 10 people in your home — that you have no right to say ‘no’ to. You are invaded. We want to make sure that the bereavement support is a choice you’ve made.”

The group also explored the reality that not all suicide deaths impact communities in the same way. For instance a school that has been rocked by multiple deaths usually experiences heightened anxiety and fear as rumors escalate. For these communities, “returning to normal” might require more conversations of assurance.

One participant described this particular tension in postvention: “Grief is a natural process, and when you put shutters around it, damage can be done. The bereaved will let you know what they need; our role is to support them.”

While the cultures and languages of this diverse group of experts varied, the themes of the challenges were similar. By sharing lessons learned and stories of success, we forged a solidarity in our efforts to support people bereaved by suicide.

Reference:
Bonanno, G. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20-28.

Sally Spencer-Thomas is CEO and co-founder, Carson J Spencer Foundation, founded after the suicide of her brother. The foundation is known for preventing suicide in the workplace, coaching youth social entrepreneurs to be the next generation of suicide prevention advocates, and supporting the bereaved. She is AAS Survivor Division Chair.

"Reposted with permission from the American Association for Suicidology" follow
this link to see the article in Newslink.

 

Wednesday, March 16, 2011

Tsunami: The Aftermath of a Suicide Crisis


My brother Carson died by suicide December 7, 2004 -- the anniversary of the bombing of Pearl Harbor, two weeks before Christmas, and two weeks before his 35th birthday. It was also two weeks before the Asian tsunami. As the world reacted to that disaster, the aftermath of Carson’s death similarly hit our family, as we too were flooded, overwhelmed, and left helpless. The news of his suicide crashed tsunami-like around us – totally engulfing us in despair and darkness. Frozen and in shock, we fought for every breath, thinking “This cannot be happening.” I confused night with day, day with night. I remember feeling very, very vulnerable. I would be driving to the airport to pick up a guest for Carson’s memorial service and I would look up and have no idea where I was or what I was doing. Then I would be hit by a wave of panic as I were sure everyone on the road was going to hit my car.


After the birth of my third child in September, I had been on maternity leave for the months leading up to Carson’s death. I had burned up all my sick and vacation time, and the three days we are given to grieve a first degree relative. I needed to resurface and go back to work. I remember coming up for air and looking around; the landscape had changed because my brother was no longer in it. Everything looked and felt different. Things that were so desperately important at work before no longer mattered. I both dreaded and welcomed my first day back to the office. Dread because I just didn’t care anymore; desired because I missed the structure and sense of purpose my workplace provided me. I remember the first day back. I opened my office door to see a pile of cards and flowers on my desk. My inbox was filled with well-wishes, many from people I didn’t even know. I knew with this level of support that I would be okay. My workplace gave me the flextime to access our Employee Assistance Program and attend support groups, which I did. They told me to do what needed to do to get back on my feet, and I am forever grateful for their kindness during this very trying time in my life.

Just like the tsunami, the ripple effects of Carson’s death spread deep and wide, and to this day still continue to affect others. Thanks to social media, I am still connecting with people Carson knew who are just now learning of his passing. His co-workers and business partners established a scholarship in his memory designed to help young entrepreneurs get to college. This loving affirmation of my brother’s life carries on his gift of helping others and gave many of those connected through his work a chance to honor his life.
The aftershocks of the trauma were severe at first, some of them predictable like on Father’s Day, his wedding anniversary, his birthday, and certainly his death anniversary. Others caught us off guard, like the time I was digging through a box of photos. I found a picture that I had forgotten about, of us dancing at my wedding. Not many brothers and sisters dance to their own song when they get married to another person, but Carson and I had a song: Whitney Houston’s “I Will Always Love You.” Whenever we heard it on the radio we would belt it out to each other at the top of our lungs as silly as possible. At my wedding, Carson and I twirled around the dance floor – my hair coming out of the up-do, his shirt hanging untucked from his tuxedo. And someone snapped a picture as we joyously sang the chorus, eyes locked and laughing. When I found this picture, I wept and wept. Then I made a copy of it to hang next to my computer at work, so I would never forget.

As with the tsunami, the rebuilding process has been long and hard, requiring many systems of support. In this sense I often feel lucky, because unlike many survivors of suicide I had a workplace that was supportive, a faith community that understood his suicide as the fatal outcome of a mental illness (not a crime against God), and a network of friends and co-workers who did all the right things.

I don’t tell this story because I want pity or because I need sympathy. While losing Carson has clearly been the most difficult experience of my life, I have been given many gifts along my grief journey. I was reminded of this by the leader of the rock group Seether, who lost his younger brother to suicide and wrote a song called “Rise Above This” on the album Finding Beauty in Negative Spaces. This too has been my experience in grief. I have found depth in relationships and spirituality and an unwavering calling of vocation. No, I don’t want anyone to feel sorry for me. I tell this story because so few families do, and thus, people think it can never happen to them. While I am humbled by this experience, I am also hopeful. Suicide is arguably one of the more preventable causes of death, so I also share this story in hopes that others will come forward and say, “I too have been affected, and I want to make a difference - how can I get involved?” And finally, I share this story because people who are in a suicidal crisis often think they those who love them will be better off without them. I am here to tell them that suicide causes a legacy of trauma and pain that continues for generations. No matter how hard it gets, you never know what is waiting for you around the corner.

On the Power of Ritual to Make Meaning for Survivors of Suicide Loss

Reprinted with permission from the American Association of Suicidology's Newslink newsletter

Many of us who are caught up in the conspiracy of busyness are often cut off from our grief. In many cultures in the U.S., we are trained to be fearful of death; we are conditioned to “get over” our loss and move on as quickly as possible. However, as a Jewish prayer states, “We do best homage to our dead by living our lives fully even in the shadow of our loss. Our grief is what allows us to begin to live our lives fully again after loss.” One of the ways I have found to work through the grief and loss of my brother’s suicide is through healing rituals.

Rituals are symbolic actions that usually acknowledge or honor transitions in our lives and can be very powerful tools for processing our emotions. For one, they can provide some containment for what feels like a chaotic, out-of-control experience. We usually don’t know what to do, especially in the aftermath of an unanticipated trauma like suicide. Rituals sometimes have very soothing, reassuring aspects to them and give our minds something meaningful to focus upon.

Many other reasons for the effectiveness of rituals exist. When words don’t suffice, rituals offer symbolic means to communicate. Community rituals help build a sense of solidarity. As we try to figure out a “new normal” in our individual and family lives, rituals can help give us structure. Rituals can become intentional releases like pressure valves; they can bring forth cherished memories and connect us to what matters most. Every year I engage in and facilitate a number of rituals for myself, my family and my community. Here are some:


Rituals of remembrance: Probably the most common rituals for grieving a loss are rituals of remembrance. Lighting candles in honor of our loved ones is a powerful and beautiful acknowledgement of the light they brought to the world. Saying the names of our deceased loved ones out loud also has a strong impact. I remember after my brother died by suicide, I was at a complete loss on what to do on Father’s Day for my Dad. When I meditated on this question, the image of a Weeping American Elm flashed in my mind’s eye. Planting a tree together provided a ritual that symbolized Carson’s enduring spirit and the seasons of our lives. Watching the tree grow reminds us that our bond with him continues.
Rituals of communication: Rituals of communication can give us the opportunity to say the things we couldn’t or didn’t while our loved one was alive. One way to do this is by writing a letter or a poem to our loved one.

Rituals of nurturing: Grieving is hard work, and often we are so overwhelmed by the intensity of our emotions, we forget to take care of ourselves. In the process, we can find ourselves drained or continually sick, and this just adds to our misery. Having a “comfort box” nearby can give us some ideas on how we can replenish ourselves. Soothing music or aromatherapy might be nurturing for some. Other people might include religious passages or affirmations that they find grounding. Pictures or stories that make us laugh or warm our soul can also help.

Rituals of reflection: In our busy lives we often find it hard to pause and reflect on where we have been, where we are at and where we are going. Rituals of reflection give us the space and structure to do this. Sometimes this form of ritual can be through meditation or prayer. Others times we may find journaling or drawing serve this purpose. I find long periods of meditation open up channels of thought or insight I cannot get in any other way. I follow these practices with journaling around the insights I have received, and I often look back on these entries to “connect the dots” of themes in my entries.

Rituals of community connection: Many of the local and national suicide prevention walks offer rituals of community connection as a way to publicly honor our loved ones and create a sense of belongingness among bereaved people. I have seen balloon releases, dove releases, and “mardi gras” bead wearing as examples of these community practices. At our AAS conference each year we have our survivor quilts (quilts made to honor our loved ones who died by suicide) displayed. These group rituals let us know we are not alone in our pain.

Rituals of release: Sometimes we have places in our grief that seem to get in our way. Guilt, anger, and regret can fester and keep us stuck. For rituals of release, some people have written these thoughts out on paper and then have burned the paper as a symbol of letting these toxic emotions go. Others have buried symbols of these emotions in the ground.

On the anniversary of my brother’s death, I bring out everything I have that reminds me of him. I usually take the day off from work and have the house to myself. I watch videos, look at pictures, and read the letters he wrote to me. I smile as I read the 10-year-old handwritten note he send me while I was at summer camp. I cry as I watch the video of him joyously playing with his daughter. I look at the pictures of us hugging at different ages in our lives and think, “he loved me, he loved me, he loved me.” And I put my finger right on the grieving, because I never want to lose touch with why I do this work. I will always remember, and I believe he walks with me as I go on this journey.

At the close of the Healing after Suicide Conference in April, we will have a healing ceremony for survivors of suicide loss. If you have a ritual you have found to be particularly powerful that can be done in a large group setting, I would love to have your ideas. Please, email me at Sally@CarsonJSpencer.org.
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For more resources for Survivors of Suicide Loss visit the American Association of Suicidology: click here.

The Carson J Spencer Foundation offers families recently bereaved by suicide iCare Packages (semi-customized resources packets). For more information: click here.

What rituals have helped you or others who have been bereaved by suicide?