DAY 10 - World Suicide Prevention Day 2021

 

Every year, World Suicide Prevention Day falls on September 10th. 

This year, take a moment to reach out to those you care about who have high risk factors for suicide.

If you know a trans person, or a child who is being bullied, reach out. If you know a veteran with PTSD or someone who endured childhood trauma that resulted in CPTSD, reach out. If you know someone who struggles with bipolar disorder, or major depressive disorder, or OCD, or any other mental illness, reach out. If you know someone who struggles with addiction or alcoholism or an eating disorder, reach out. Maybe you know someone who has attempted suicide before, or someone who has lost someone to suicide (both of which are suicide risk factors, too) - reach out.

Today is a good day to reach out to the people you are concerned about, the people you love, and the people whose lives have been touched by suicide. Sometimes one conversation, one reminder, one person telling another that they love them - sometimes this is all that is needed in order to shift someone from thinking about suicide, to thinking about getting help. 

Reach out.

The World Needs To Be Ready

Lorna Breen, MD, Emergency Room Medical Director

New York Presbyterian Allen Hospital

This traumatic episode in history, on a massive scale, will be studied for years to come. We know that after trauma comes the post-traumatic episodes and the world needs to be ready to help those who will need to be mentally supported once the worst is behind us.

― Aysha Taryam

Those of us with an understanding of Post Traumatic Stress Disorder (PTSD) who've been following the news (especially that coming out of Italy and New York) are likely less surprised that Lorna Breen,  a successful ER doctor in New York, died by suicide a few days ago. We are no less heartbroken, but less surprised because we could see this brewing. For those serving on the front lines of the COVID-19 pandemic, there is a perfect combination of the circumstances that lead to PTSD. 

Last month when I first read about what was happening in Italian hospitals, I shuddered. The overcrowding, the lack of beds, supplies, and medical personnel. And the number of people dying from this virus, despite heroic attempts to keep them alive. Doctors were often put in the agonizing position of having to determine who would receive lifesaving measures, and who would not. 

Most doctors go into their field in order to save lives. The Hippocratic Oath, the most basic tenet for medical doctors, states first: do no harm. But here, they were having to decide who they would let (likely) die in order to provide services to someone else. Having to make that type of decision flies in the face of 'do no harm.' This ethical bind alone will shake even the most stoic of medical personnel.

Looking at the causitive factors of PTSD, we can not deny that a pandemic the nature and scale of COVID-19 is going to have a lasting effect on hundreds of thousands of people - if not more. Some have called this pandemic 'the invisible war', Without going into the politics of who said it or why - it seems to be an apt term. Now consider that research on PTSD has shown that it is caused by certain circumstantial elements. One of the most common is a person's sense of helplessness when experiencing/witnessing a life-threatening or fatal event.

Children get PTSD from traumatic events (especially long term neglect or abuse) because inherently, they are without recourse when it comes to stopping the situation. Those who are physically, sexually, or emotionally abused/assualted are also often victims of PTSD. And for military troops in combat, PTSD runs rampant. In all of the above cases, we can see that a common thread is feeling as though there is a terrifying lack control over a traumatic situation.

Another factor in the likelihood of developing PTSD has to do with a perceived sense of responsibility. Loss that results in survivors guilt has a profound impact on the person suffering. This type of guilt and shame is a significant driving force in the development of PTSD.

For front line personnel in the areas hardest hit by this pandemic, in order to work, their psychological emotions are often in freeze mode. Physiologically they are inundated with a constant stream of stress hormones, specifically adrenaline and cortisol. And while both adrenaline and cortisol serve a purpose, long term exposure can be perilous to physical and mental health. When this happens, the deck for a healthy trauma response is stacked against a person.

If you are thinking that medical personnel should be trained to mentally/emotionally handle this type of trauma and loss, thinking along those lines is both dismissive and dangerously mistaken. Even prior to this pandemic, in the United States doctors die by suicide over twice as often as those in the general population. In the case of the armed forces, military medics represent a significant portion of those who die by suicide. More concerning are studies that have shown that among first responders,  those who indicated being regularly pushed to work past exhaustion and burnout are significantly more likely to die by suicide than their counterparts.

In the communities hardest hit by this virus, the medical personnel who are managing the sickest of those diagnosed with COVID-19 feel helpless when it comes to managing a novel coronavirus with no significantly effective treatment yet available. While many are having to confront the most brutal aspects of this virus, over and over again - they also feel the strain of an expectation that they should be able to comfort and heal patients. Combined, we have the perfect stew for developing a PTSD that leads to suicidality.

How do we help the health care professionals who are in this situation? The first thing to do is to acknowledge that there is very real possibility they are dealing with PTSD and recognize that suicidal ideation can be one of the symptoms of PTSD.

Recognize the increased risk factors, and go from there. Learn the warning signs of suicidal ideation, and learn what to do if you are concerned someone is suicidal.

Treat doctors, nurses, and hospital staff with kindness and caring, always. These are very frustrating times for all of us. Our entire world is dealing with the stress, inconvenience, and pain around this pandemic. If you have feelings of frustration around social distancing, shelter in place mandates, or other pandemic control practices - medical personnel are not the people to take these frustrations out on. Do what you can to support your neighbors and friends who are working in the medical/hospital/emergency services field. Reach out, text, or make a phone call. Ask if you can have a meal delivered to them at home or at work. Communities that are sending lunches and dinners to entire emergency rooms and/or intensive care units, are doing a good job of letting the staff know that they are seen and appreciated. Equally, when people are coming together to make noise to celebrate their medical personnel (virtually at a certain time of day, or in person during shift changes, etc.) there is a profound benefit. When a person feels as if they are seen, appreciated, and cared for, they feel less alone and helpless.

We are confronted with enough loss of life when it comes to COVID-19. Let's not let suicide lend to additional casualties. The world needs to be ready to support the first responders in this invisible war. So, do this today. Tell someone on the front lines that you care, and that you appreciate everything they do. Sometimes one measure of kindness can be the difference between despair and the ability to go on another day.

Day 30 - Grace's Arrival

I wish that grace and healing were more abracadabra kinds of things.

Also, that delicate silver bells would ring to announce grace's arrival.

But no, it's clog and slog and scootch, on the floor, in the silence, in the dark.

- Anne Lamott

Today is the last day of Suicide Prevention Month. Of course, for those of us whose lives have been touched by suicide, we know that this only means so much. The pain, frustration, grief, and fear around suicide are always there. For many of us, we learn to live with an acceptance. For survivors of suicide loss, we must come to an understanding that this tragic loss happens, and that it has happened to us. For survivors of suicide attempts and for those with suicidal ideation, we must come to accept that there are times when the strength required of us in the face of emotional torment, is deeply unfair and heartbreaking. In fact, no matter who or where we are on the spectrum of having been impacted by suicide, those two things are true: it is unfair and heartbreaking.

Still, I must say this. In my life, in all matters that have involved great pain, there is a profound grace in coming to an acceptance. It is nearly always the first step in allowing comfort in. Acceptance of our pain is the first step in asking for help. Acceptance of the pain of others is the first step toward the life saving graces of compassion and empathy. Acceptance of having been broken by something, is the first step toward healing.

Over the past few years, with the help of a great many caring people, I have come to understand that there are times when we must admit that we are powerless. The irony is, it is only in this admission that we being to find our strength. And I have learned that telling your truth has the capacity to heal not only you, but also others. These lessons have been profound gifts to me. They are in large part, why I share myself so publicly, today.

Let me tell you more about where I find my strength and why I share.

My life is in danger.

Not in immediate danger. But close enough. And the reason is this: when combined, my overall risk of suicide is devastating. I should be wearing a medical ID bracelet. Really. Instead of explaining that I have diabetes or a seizure disorder, it should say:

"This woman's will to live is potentially in peril. Remind her that she is strong and brave."

Let's look at the totality of my risk factors:

I suffer from PTSD. That places my risk at 20%+ higher than the general population.

I have an eating disorder. Specifically, I suffer from restricting anorexia. Eating disorders have the highest mortality rate of all mental illnesses. Their mortality rate is higher than that associated with schizophrenia, bi-polar and major depressive disorder. And of eating disorders, anorexia has the highest rate of completed suicides. I am in remission, but as all of us with and eating disorder know, this does not guarantee a lifetime free of relapses.

I am an alcoholic and drug addict. This puts my risk factor at 10% - 15% higher than the general population. I am in recovery, so I am at the lower end of that percentage rate, but abstinence alone does not negate the increased risk of suicide for those of us with a chemical dependency.

I have had two past suicide attempts. One of the more concerning risk factors. Among those who report suicidality, once an attempt has been made - their risk factor of eventually dying by suicide is increased tenfold.

I have been hospitalized numerous times. Another risk factor that could be seen as particularly ominous. For those of us whose mental illnesses have incapacitated us to the point of psychiatric hospitalization - our suicide rate is 44 times that of the general population.

I am a survivor of suicide loss. Times two. Having lost a mother and having lost a partner/spouse puts me in two of the highest categories of increased risk.

I am a survivor of severe childhood bullying. Suicide is the second leading cause of death among young people and half of all those suicides have been deemed to have a direct correlation with having been bullied.

I am a survivor of past sexual abuse.

I've had two head injuries. Once when I was 12 years old, I was hit in the head with a bottle. It knocked me unconscious. To this day I can feel a bump on the back of my head where stitches left a scar. And then a second time 20 years later. I broke my nose (while surfing of all things). Studies have shown that for those of us with even just a single concussion, our suicide risk is three times that of the general public.

At the time of my suicide attempt five years ago, I didn't understand the totality of my risk factors. My belief up until that point was that I would be able to make a final decision to live and that I could stop being selfish, stop being broken, stop being bad, and not be suicidal ever again. Every time my suicidal feelings returned, those feelings of being selfish, broken, and bad were cemented internally. Every time I reached a point of desperation again, every time my suicidal thoughts presented themselves, I truly believed that I had failed myself, and I had failed those who loved me. Living with that sense of failure and the resulting shame, made my finding a will to live that much more difficult.

It has taken me many years to understand that it is those risk factors and not an inherent brokeness on my part, that leads to my suicidal ideation. Some of my risk factors can be managed and therefore mitigated, but none of them will ever go away, entirely. Until we better understand how to address the damage done to the synapses in the brain when physical/emotional/mental trauma occurs, it will be very difficult to mitigate those risk factors in their entirety.

My acceptance looks like this:

If I could make the decision to never be overtaken by suicidal feelings again, I would have. In fact, I have made that decision many times. But this issue is only partially about the decisions that I am making. Much of this is out of my hands. So the decision I must make on a daily basis, is to understand the degree to which my life is at risk, and to always reach out for help. Always. Always. Always.

I say this thing. It is figurative. But it is the truth as well. In the first year after John died, I didn't drink, but I didn't manage to stay sober. I didn't live through it, but I stayed alive. I relapsed into my eating disorder, but I did not die of starvation. Here is why:

I only survived because other people held me up. I stayed sober because other people stayed sober for me. I stayed alive because other people stayed alive beside me. I lived through my eating disorder relapse, because other people told me, over and over again, how important it was that I not let it kill me.

I didn't live through the past year and a half. Other people held onto me and lived through it for me.

One of the most poignant conversations I had following John's death, was with his mother. She was reminiscing about a time when she was young. She shared about the hopes she had then, of getting married one day, starting a family, having children of her own. When she shared this she looked wistful at first, and then her face fell. She looked down. She was thinking of her two boys, David and John, I know.

"How could I have known that this is what would happen to my children? To my family?"

So I thought about her words and the memories of who we all were in the past, before heartbreak befell.

My father has long told me that when I was a baby, I was always smiling. That in and amongst the chaos of having a mother who was so often lost in her own incapacitating mental illness, I was always smiling.

I thought about it for this reason. Because John's mother does have a beautiful family. And her children are beautiful. All three of them. Living or not. I never met David, but I can say with certainty that so far as John is concerned, the world is a better place because of his having lived in it.

And along those same lines, I now understand that I get to let go of the hand of innate brokeness that I held onto for so long. At my core, I no longer have to be a broken person. The core of who I am, I know, is that smiling child who somehow found a way, even in bleak circumstances, to live in a place of joy, in this broken hearted world.

So, it is with that in mind that I will reiterate my commitment to keep up this fight. Not just for my life, but for the lives of everyone who has been touched by suicide. I am fighting for the memories of those who are no longer with us, I am fighting for those who are struggling with thoughts of suicide right now, and I am fighting for the survivors of suicide loss who are enduring a pain like no other.

Perhaps I don't need that medical alert bracelet after all. In many ways, because of my risk factors I live a life that is in peril. But I know that with the love and support of others, I am able to live that life with strength and bravery, too. That, is where I find my grace.

Perhaps the little girl that I once was, smiled so often because she knew that so long as she was able to face another day, she was also able to welcome grace's arrival.

Remember: End the stigma. Have the conversations. Make resources available. Fund the research. Begin now.

Day 28 - A Whole Body Tragedy

PTSD is a whole-body tragedy, an integral human event 

of enormous proportions with massive repercussions.
― Susan Pease Banitt

Let's talk about Post-Traumatic Stress Disorder (PTSD). Our internal response to trauma is often the platform for suicidal thinking, behaviors, and completions. If we do not understand and address the role trauma plays in the lives of individuals who die by suicide, we won't achieve comprehensive suicide prevention.

To better understand the connection between suicide and PTSD, let's start with a definition. Post-traumatic stress disorder (PTSD) is a psychiatric condition that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. PTSD can also occur after sudden severe emotional trauma such as experiencing the unexpected loss or death of a loved one. Finally, PTSD can also occur after prolonged exposure to environments in which a person is being bullied, neglected, or suffering abuse (physically, sexually, mentally, emotionally, or otherwise).

To put this into perspective, let's look at some data:

• An estimated 70 percent of adults in the United States have experienced a traumatic event at least once in their lives and up to 20 percent of these people go on to develop PTSD.
• An estimated 5 percent of Americans—more than 13 million people—have PTSD at any given time.
• Approximately 8 percent of all adults (1 of 13 people in this country) will develop PTSD during their lifetime.
• An estimated 1 out of 10 women will get PTSD at some time in their lives. Women are about twice as likely as men to develop PTSD.

And again, putting the suicide/PTSD link into perspective, when we look at those who are the highest risk of suicide, a diagnosis or probable diagnosis of PTSD is pervasive:

Those serving in the military.
First responders.
Those having been bullied.
Individuals who identify as part of the LGBTQ community.
Those having suffered sexual abuse.
Those having suffered a head injury.
Survivors of suicide loss.

Given the close connection between trauma and death by suicide, we have to look at what is happening to the brain, during severe or prolonged traumatic events.

Many people incorrectly assume that PTSD is related to purely mental/emotional reactions to these events. This misconception is not only highly stigmatizing - it is also inaccurate. Unfortunately this stigma impairs our ability to prioritize the research needed to improve treatment of PTSD. Stigma suggests that PTSD only happens to those who are not emotionally strong enough to manage their feelings during and after trauma. This belief is very damaging because it further shames those who are suffering, and profoundly denigrates the deceased.

Here is a graphic that shows what is actually happening at the inception of PTSD:

What the graphic shows is that during trauma, your emotions and reactions are dictated by physiological responses and not by rational thinking. Survival mode is not conducive to well thought out rational behavior. By matter of necessity, we react based on sights, sounds and emotional stimuli. We are not reacting based on thoughts or access to cognitive information. Our behavior becomes singularly oriented toward avoidance of further pain and trauma. Our actions are guided by physiological changes in the brain, not thought processes. Here are the most important words in the graphic above, as they apply to our traumatic events:

This is NOT a cognitive choice.

The physical and mental response to trauma has nothing to do with thought, cognition, decision making, personality, weakness, or strength. It has everything to do with a brain's physiological response to the trauma.

Following trauma, some brains are unable, without effective treatment, to maintain consistent physiological stability. Some reasons are known, many more are not. More research is desperately needed.

For those with PTSD, they may have periods of significant stability, where they are able to manage many of life's normal ups and downs with appropriate levels of pain and frustration. When their PTSD is activated however, their reactions to normal stressors may seem heightened to a level that appears unreasonable. Some of the symptoms of PTSD include ongoing emotional distress, personality disturbances and/or changes, severe anxiety/aggression/depression and poor impulse control. All of these symptoms, while seemingly based in 'thought processes', are actually dictated by the same brain changes that occurred at the inception of the PTSD.

Some of the most successful treatments for PTSD involve behavioral therapies, not necessarily cognitive therapies. In other words, we are seeing success in treating those with PTSD when we work to provide them with skills for recognizing and managing symptoms when they occur. Traditional 'talk therapy' that encourages a person to remember and discuss events in their life, has shown a propensity for re-traumatizing those with PTSD. We must make long term and easily accessible behavioral (skills based) therapies available to all individuals who are suffering from PTSD.

There are other significant developments in PTSD research. Researchers have found that the condition can be detected via brain scans.

"Brain imaging studies have shown alterations in a circuit including medial prefrontal cortex (including anterior cingulate), hippocampus, and amygdala in PTSD. Many of these studies have used different methods to trigger PTSD symptoms (eg, using traumatic cues) and then look at brain function. Stimulation of the noradrenergic system with yohimbine resulted in a failure of activation in dorsolateral prefrontal, temporal, parietal, and orbitofrontal cortex, and decreased function in the hippocampus.173 Exposure to traumatic reminders in the form of traumatic slides and/or sounds or traumatic scripts was associated with an increase in PTSD symptoms, decreased blood flow, and/or failure of activation in the medial prefrontal cortex/anterior cingulate, including Brodmann's area 25, or subcallosal gyrus, area 32 and 24, as measured with positron emission tomography (PET) or functional MRI (fMRI)"

What do all those words above amount to? Again:

PTSD induced behaviors and 'decisions' or 'choices' actually reflect the physical impact of traumatic events on the brain's ability to respond, and do not reflect decisions or choices.

PTSD is a formidable enemy when it comes to suicide, but there is hope. With more research, we will be able to further streamline finding the best behavioral therapies to support those with PTSD symptoms, and we may be able to identify other treatments that could have a restorative effect on the damaged brain functioning that occurs when PTSD is present.

If you suffer from PTSD, know that your symptoms are not your fault and not a product of your being weak, or selfish, or 'unable' to handle your problems. Know that there is hope and there is help, and that many people are fighting to ensure that better treatments are on their way.

If you love someone with PTSD, please keep all of the above in mind, educate yourself further, advocate for your loved one so that they have access to support services and treatment of their own, and reach out for support for yourself. And always have the suicide prevention lifeline phone number (1-800-273-8255) on hand. (There is a special number for those in the military, as well.)

And if you have lost someone to PTSD, let me say this: For my generation and all of those prior, we have spent our entire lives conditioned to believe that when someone dies by suicide, they made a 'choice' of some kind. We take that belief and compare and contrast the 'choice' to die with a choice we think they could have made to stay alive and be a part of our lives.

The questions we are asking are agonizing. They are also inaccurate. With PTSD, the accurate question, is this:

What impacted my loved one's thought processes so that they were unable to make the choice to live?

That is the question that we must answer. Those answers will lead us to the solutions that will begin to appreciatively save lives.

We must end the stigma. Have the conversations. Make resources available. Fund the research.

BEGIN NOW.

Day 27 - Brain Injury and Suicide Risk

Tiaina Baul "Junior" Seau Jr.
January 19, 1969 - May 2, 2012

NFL linebacker.
10-time All-Pro. 
12-time Pro Bowl selection.
Named to the NFL 1990s All-Decade Team. 
Elected to the Pro Football Hall of Fame.
In 2012 Seau died by suicide. 
He was diagnosed with CTE posthumously.  
Junior Seau was 43 years old when he died.

The link between brain injuries and suicide is undeniable. Studies have shown that both major and minor traumatic brain injuries (TBI) increase suicide risk. Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease often associated with athletes, is the result of having suffered multiple head traumas.

The list of those with CTE who had no prior history of mental illness, and then began exhibiting symptoms and/or died by suicide, is extensive. Here is a partial list of Former NFL players with confirmed CTE:

• Jovan Belcher^[4]
• Forrest Blue^[5]
• Bill Bryant^[6]
• Lew Carpenter^[7]
• Dwight Clark^[8]
• Daniel Colchico^[6]
• Lou Creekmur^[9]
• Art DeCarlo^[6]
• Shane Dronett^[10]
• Dave Duerson^[11][12]
• Pete Duranko^[6]
• Ray Easterling^[12][13][14]
• Frank Gifford^[12][15]
• Cookie Gilchrist^[12][16]
• John Grimsley^[17]
• Chris Henry^[12][18]
• Aaron Hernandez^[19]
• Jim Hudson^[6]
• Gerry Huth^[6]
• Tom Keating^[6]
• Terry Long^[1]
• Rob Lytle^[20]
• John Mackey^[12][21]
• Ollie Matson^[12][22]
• Tom McHale^[12][23]
• Earl Morrall^[24]
• Paul Oliver^[6]
• Joe O'Malley^[6]
• Mike Pyle^[6]
• Adrian Robinson^[25]
• Scott Ross ^[26]
• Tyler Sash^[12][27]
• Junior Seau^[12][28]
• Bubba Smith^[12][29]
• Robert Sowell^[6]
• Ken Stabler^[12][30]

The list above is woefully incomplete. At present, CTE can only be diagnosed post mortem. Some families are not comfortable donating the brains of their loved ones for autopsies related to CTE research. Also, understanding how to identify CTE is relatively new. Recognizing and diagnosing the condition has only been possible since 2002. Prior to that, the degenerative brain disease was not yet understood.

CTE was initially identified by the pathologist Bennet Omalu, MD, who performed the autopsy on former NFL player Michael Webster.Webster was 50 years old when he died. Webster had slowly developed increasingly significant symptoms of mental illness during his career in the NFL and following his retirement. After extensive research, Dr. Omalu was the first to discover abnormal proteins in his brain, referred to as neurofibrillary tangles. Today, brain imaging scans show the  permanent impact that concussion related CTE has on a brain:

For those living with the disease, the symptoms are devastating.

(Image above from the Patrick Risha Stop CTE Awareness Foundation)

Given this, understanding and addressing the risk of dying by suicide when a person has suffered a head injury is critical to overall suicide prevention. We must do more research on how to identify brain injury, as often a person who has incurred an injury initially has no (or very minor) outward symptoms.

It is absolutely imperative that people understand that the physiological response to (even minor) head injuries can have a profound impact on long term behavioral symptoms. The two are inextricably linked. Recent studies have shown that having suffered just one concussion leaves a person with a suicide risk that is three times that of those who have not had a head injury at any time during their life.

The urgency of needing more research speaks for itself. Postmortem is not an acceptable time to diagnose a fatal disease.

As a survivor of suicide loss, I also need to say this. The discovery of CTE makes a very important statement about the impact of stigma on suicide. Consider that until CTE was diagnosable, the public perception of of those who suffered from the related symptoms of mental illness and/or died by suicide, was accusatory and ugly. Like all who have struggled with these issues or lost their life in this way - those with CTE were often considered weak of character. Many athletes who died by suicide were deemed selfish and unappreciative of their success.

The pervasive belief that individuals suffering from symptoms of mental illness and who die by suicide are at 'fault' for their death is often wholly inaccurate.

The vast majority of the public still believe that a person who dies by suicide was making a 'choice' that they had entire control over. This is a belief that leads to agonizing questions asked by those left behind. This stigma is believed by the majority of the public, including those who have lost someone to suicide and those who are directly suffering from mental illness. Considering the fact that even one concussion raises suicide risk, why aren't we making diagnosis, awareness, and treatment of CTE and related conditions more of a priority?

Why aren't we comforting those who have lost someone to suicide by telling them that there are often definitive physiological reasons behind years of erratic behavior and suicidality?

Survivors of suicide loss torment themselves with guilt and rage related to questions around why the person they lost did not love them enough to stay alive, or why their own love wasn't enough to keep someone alive.

Again, it is critical that we do more research and that we develop better tools for diagnosis, treatment, and management of all factors that contribute to suicide risk, CTE and head injuries included.

Day Seven - The Strongest People I know

Suicide loss survivors are the strongest people I know. That's just the truth. Whether it is the endurance of heartbreak that has made them strong, or it is the steadfast presence of their love and concern for others that makes them strong, I don't know. But what I can tell you is that the extraordinary compassion of those who have suffered these losses can be profound. In the support groups that I belong to, whenever a new member joins, we tell them how glad we are they are with us, how sorry we are they are with us, and then we remind them that they are not alone.

If you are survivor of suicide loss, please always remember this: you are not alone.

Suicide loss is a grief like no other. There is no 'getting over' the loss. Most of us learn to live around the grief. I've described it this way: the heaviness of the pain does not go away, but the muscles we use to carry it get stronger.

Studies have shown that the grief related to suicide loss is felt more intensely and often lasts longer than the grief related to other types of loss. For some, the grief is completely incapacitating. When these incapacitating feelings last beyond a few months, we may be experiencing Complicated Grief Syndrome (known clinically as Persistent Complex Bereavement Disorder). Without help, it can be very difficult to overcome the symptoms on our own.

According to the Mayo Clinic, the signs and symptoms of complicated grief are often the same as with other types of grief, but they do not lesson or abate as time goes by. These symptoms may include:

• Intense sorrow, pain and rumination over the loss of your loved one
• Extreme focus on reminders of the loved one or excessive avoidance of reminders
• Problems accepting the death
• Numbness or detachment
• Feeling that life holds no meaning or purpose
• Experiencing overwhelming guilt or self-blame
• Believing that you did something wrong or could have prevented the death
• Experiencing overwhelming anger or blaming others
• Feeling life isn't worth living without your loved one
• Wishing you had died along with your loved one

Again, it is important to know that all of the above feelings are common and normal when grieving the loss of a loved one. Complicated Grief Syndrome is indicated when a person is stuck in one or more of these stages for a prolonged period of time without being able to function in other areas of life.

It is very important to know that survivors of suicide loss are a a higher risk of suicide themselves.  

While a genetic predisposition may be part of the reason we see more than one suicide among family members, it is undeniable that the intensity of suicide-loss grief seems to play the largest role in elevating the risk factor of individuals who have lost a loved one. In fact, it is the spouses and partners, and then the parents of those who have died by suicide, who are most likely to die in the same way - although other family members are also at risk. Given this, the increased risk of suicide seems to be less about genetics and more about unbearable heartbreak.

If you are a survivor of suicide loss, several things are critically important:

Always remember that you are needed in this world.

Reach out for support as soon as possible.

Professional help is almost always of benefit to your grieving process. Reaching out to others is also very important. Talk to friends and family. Join support groups for those who have also lost someone to suicide.

Allow yourself to talk about and move through any guilt that you might be feeling.

Guilt is a normal stage of grief, but try to remember that suicide is very rarely the fault of another person. Reach out to other survivors and talk to counselors about how you feel. Getting support from others and listening as they share their own experiences can make a big difference.

You may find yourself blaming others for your loss. While it is important that you be patient with your feelings, it is critical that you not let those feelings dictate your behavior.

Being angry about the death of a loved one is also natural and can be expected. However, if you find that you can't stop blaming another person for the loss, speak to a professional about your anger. This is particularly important if there is any chance that you might lash out at another survivor of suicide loss.

Because of the circumstances, when the person who blamed me for my boyfriend John's death lashed out at me, her behavior represented severe bullying. I was particularly vulnerable and unable to defend myself. I can't help but think that she would have liked to have had as much support as possible from others - but because of her words and behavior she ended up alienating herself from John's family and his closest friends. Ultimately, many people were heartbroken because of John's loss - but she was the only person who was lashing out and purposely trying to exacerbate other people's pain.

Do not be the person who is attacking other survivors of suicide loss. 

Remember, feelings of guilt and anger are normal, and it is important that you be patient with all of your feelings. But, if you find that your guilt is leading you to thoughts of harming yourself, or if your anger toward others is so great that you may attack them (in writing, on the phone, or in person), please get professional help immediately.

I can not emphasize this enough. In my situation, my own guilt was already excruciating, but it was the bullying by this other person that was the most significant factor in my own suicidal feelings. I am not sure I would have survived, if it were not for my reaching out for professional help of my own.

If you are not a survivor of suicide loss, statistics suggest that you likely know someone who is. Please always be cognizant of the fact that we are enduring a heartbreaking grief that is made worse by the stigma associated with suicide. We need you to reach out to us. We need to be allowed to talk about the person we lost. We want to hear your own positive memories of our loved one. Our grief will likely be more intense and last longer than the grief associated with other types of loss. We need your patience, understanding, compassion, and empathy.

And if you are a fellow survivor of suicide loss, know that our collective strength has inspired me and at times it has eased the worst of my grief. My heart is always with us. Always.

In the United Kingdom, Anti bullying Week 2017 is being held this week. I want to acknowlege it because there is such a strong link between bullying and suicide.

In recent years, a series of bullying-related suicides have drawn attention to the issue, and the statistics on bullying and suicide are alarming: 

• Suicide is the third leading cause of death among young people, resulting in about 4,400 deaths per year, according to the CDC. 
• For every suicide among young people, there are at least 100 suicide attempts. 
• Over 14 percent of high school students have considered suicide, and almost 7 percent have attempted it.
• Bully victims are between 2 to 9 times more likely to consider suicide than non-victims, according to studies by Yale University
• A study in Britain found that at least half of suicides among young people are related to bullying
• 10 to 14 year old girls may be at even higher risk for suicide, according to the study above
• Bully-related suicide can be connected to any type of bullying, including physical bullying, emotional bullying, cyberbullying, and sexting, or circulating suggestive or nude photos or messages about a person.

Bullying can take place when one person has power over another, or peer to peer. (Including adults who bully other adults.)

Adult bullying can have consequences as severe as children bullying other children, up to and including victim suicide. 

Learn to recognize bullying. It can take many forms:

If you are not the one being bullied, but you witness the behavior or you hear about it - remember that it is often far easier for you to confront the bully than it is for the person who is being bullied.

Intervene when you see a bully, and tell them that their behavior is unacceptable.

Here are some ways to stop bullying behavior:

1. Stand up for people who are bullied. Bullies often want an audience and approval. Specifically tell them that their behavior is not acceptable and that they are not welcome to be around you if they continue to behave this way toward you or another person.
2. If you are not the person being bullied, let the victim know that you are on their side and will speak up for or with them.
3. Tell other people that the bullied person needs to be supported.
4. Talk to adults, teachers, HR Departments, Supervisors, etc. Enlist the support of those who have any control over ensuring that environments are safe.
5. Do not tell the bullied person to get over it, let it go, or accept the behavior. Bullying is not acceptable and it is not the responsibility of the person being harmed to fix or change the situation.

What do you do if you recognize that you are a bully?

1. Stop the behaviors.
2. Apologize.
3. Ask what you can do to rectify a situation.
4. Commit to not engaging in the same behaviors.
5. Ask others to point out to you when they see it happening.
6. If it is difficult for you to stop the behaviors, get professional help.

Any act of intentional cruelty can be considered bullying.

If acts of intentional cruelty are repeated more than once, they fit the definition of bullying.

Note that many schools, businesses and even states have laws against bullying and intentional harassment. Bullying can lead to suspension or expulsion from schools, professional demotions or termination, restraining orders, other legal consequences, even jail time.

For the bullied person, quality of life, self esteem, and sense of overall safety can all be severely compromised. All of these things, when heightened, can lead to suicidal thinking and attempts. Again, bullying can be a significant contributing factor of suicide among young people. 

Remember, advising a bullied child or adult to just ignore the behavior may not be helpful and can actually contribute to the shame felt by the victim. Intervention is important, and providing active support to the person being bullied is critical.

Pledge to speak up and support those you see being bullied, today.

There are many excellent websites that provide more information on bullying. You can find a short compilation of some of those organizations, here.

There are also a number of excellent books and movies about bullying. At present, Netflix is streaming the movie, A Girl Like Her - a movie that depicts the connection between bullying and suicide.

Make a commitment today to learn more about how to recognize the signs of bullying and what to do to help stop it from happening. 

Together, people can make a difference in the fight against bullying.