Why do people die of suicide? Join Jana and Donna Schuurman for a discussion about this complex question. 

Two prominent theories mentioned by Donna:

Edwin Shneidman

“Suicide is caused by psychache. Psychache refers to the hurt, anguish, soreness, aching, psychological pain in the psyche, the mind. Suicide occurs when the psychache is deemed by that person to be unbearable.” 

Reference: Suicide as Psychache: A clinical approach to self-destructive behavior, (1995), p.51. 

Thomas Joiner

1. Perceived Burdensomeness

2. Thwarted Belongingness

3. Acquired capacity/decreased fear of pain of death

Reference: Why People Die by Suicide (2007). 

Eleanor and Litsa from What’s Your Grief join us as special guests to talk about becoming a parent when you’re grieving the death of your own parent or sibling. Listen in for suggestions on how to help your children build a relationship with the memory of the person who died and ways to make time for your own grief and self-care. 

Resources for talking with children and teens about death:

http://www.dougy.org/grief-resources/how-to-help-a-grieving-child/

http://www.tdcbookstore.org

http://www.whatsyourgrief.com/supporting-a-grieving-child/

http://www.whatsyourgrief.com/supporting-a-grieving-teen/

Article mentioned by Eleanor:

http://www.slate.com/articles/double_x/doublex/2014/05/mother_s_day_gift_the_value_of_writing_letters_to_your_children_while_you.html

Book mentioned by Litsa:

The Disappearance is a memoir by Genevieve Jurgensen whose two young daughters were killed in a car crash. She seeks ways to help her other children, who were born after the crash, to know and feel connected to their sisters. 

Have you ever struggled with the idea of finding closure in grief? Given grief’s ongoing and evolving nature, the search for final closure can be a misguided pursuit, one that leaves us disheartened and even ashamed. In this episode you’ll hear from a variety of grieving young adults as they break open the idea of closure and identify significant turning points in their process. You’ll learn about moments of clarity, confusion, new understandings, and what it's like when the sharp emotions rise up again. Thank you so much to everyone who contributed to this episode.

When someone dies, it creates upheaval in the support system, leading to unfamiliar territory in terms of how to help those with different perceptions and expressions of grief such as language, repetitive gestures or patterning, emotional disconnect, and searching behaviors. Although the outward expression of someone’s grief may be difficult to recognize, the need for their grief to be acknowledged and supported is universal. In this episode, Jana talks with Rebecca Hobbs-Lawrence, a staff member at The Dougy Center, about ways to support children and adults with developmental disabilities in their grief

Suggestions for supporting children or adults with developmental disabilities in their grief:

1. Acknowledge the loss by being present and responsive to their verbal and behavioral cues.

2. Affirm that they are not alone, name the support people they have.

3. Maintain a consistent routine as much as possible. Give a lot of advanced notice for when their daily routine may change or be unusual.

4. Facilitate activities or rituals that will acknowledge the grief. This can help children and adults to develop coping strategies and find ways to remember the person who died.

Resources:

Finding Your Own Way to Grieve: A Creative Activity Workbook for Kids and Teens on the Autism Spectrum by Karla Helbert, 2012

Everyone Grieves: Stories about Individuals with Disabilities and Grief by Marc A. Markell, 2013

Helping People with Developmental Disabilities Mourn: Practical Rituals for Caregivers by Marc A. Markell, 2005

Lessons in Grief & Death: Supporting People with Developmental Disabilities in the Healing Process by Linda Van Dyke, 2003

How do we help children when a family member is dying? The diagnosis of a terminal illness brings uncertainty, fear, and heartbreak into their lives, leaving the adults who love them unsure of what to do or say. In this episode, Jana talks Tony Grace about how to best support children when a family member has an advanced serious illness.

Here are some suggestions for ways to talk with them about the illness and activities to help them process their reactions, fears, and concerns.

• Children need space, time, and language to understand the changes that are taking place and that will take place in the future. If you have multiple kids of different ages, it is important to use words and phrases that are age appropriate for each of them. When communicating as a family, a good rule of thumb is to engage in conversation on a level so that the youngest child can understand, Have separate conversations with the older children and invite each child to have an individual conversation through the weeks and months ahead.

• In those conversations mentioned above, share what is happening, why it is happening, and what is most likely to happen if that is known. Be specific with names and diagnosis, but give simple explanations. It is ok if you don’t know the answers to their questions or even to your own questions.  You can make a list of questions for the next doctor’s visit or visit a local library. Librarians are a tremendous resource and they can help you and your child look for age-appropriate materials, videos, and references. Additionally, many hospitals now include a family resource center or a patient medical resource center. Ask your doctor or nurse if your facility has one.

• Don’t be afraid to mention the word death; it is not giving up on hope but a recognition that we are all mortal beings. If we are alive, our death will be inevitable at some point. Being able to talk about death, whether it be about our own, someone else’s death, or the death of an animal, can actually provide a very deep and lasting connection between family members.

• In mentioning hope, it is good to be reminded that hope can and will be redefined over and over and over again. Hope may go from wanting to live long enough to you see your children’s children to hoping that your children will grow up to be an emotionally healthy and capable adult having being taught by your role modeling.

• It is also helpful to be reminded that our stories don’t end when we die, they continue in the lives of our loved ones...including our children.  The illness and perhaps death of this family member will be part of that story, but it won’t be the final chapter.The current story that is being created is being “authored” not just by the illness, but by you, your family, and the people in your life. There is an opportunity for the story to be written in a way that can be beneficial for each person involved. Families will need to determine what that specifically looks like but generally, it looks like each person feeling informed, connected, valued, and able to express themselves.

• Many children and teens have vocalized the need to have a tangible connection to their sick family member throughout their lives. Some have asked for a memory box where they can put pictures, clothing, and other personal items. Others have wished for letters, videos, or tidbits of advice they can access as they get older. One family collected stories of the person who was ill so that their children can learn about who their father was from others. Another family had children videotape and interview the person who was ill, so in the future, they can be reminded of their interactions.

• Children with a sick family member often exhibit a lot of energy and in need of a lot of attention…and paired with a home that typically needs quiet 24/7 and focuses on the person who is ill, can often leave children feeling isolated and their energy stifled. Help identify positive ways to daily release that energy...running, sports, martial arts, gardening, dancing, etc… Neighbors, friends, and extended family members can be a great resource to help keep children active when a primary caregiver’s attention or energy is needed elsewhere.

• No one likes to feel helpless, including children and teens. Many will want to be able to care for the person who is ill, including young children. Exploring ways that can demonstrate they care, can be really helpful it helping ensure that each person feels valued. Contributions can be as simple as the drawing of a picture to hang in the person’s room, to getting water, reading a book, or massage lotion onto the person’s skin.

• For friends and family, it may be hard for families with a person who is ill to ask for help, but getting through all the challenges of a serious illness without any support is unlikely. The illness takes away many choices families have, so for those who want to help, offering to help with a menu of possible activities, rather than offering advice, or just doing something, is often advisable.  Once something has been talked about, ask how the person would like it done. This also provides another opportunity for the family to have agency over their lives.

Jana talks with Rebecca Hobbs-Lawrence, a staff member at The Dougy Center, about ways to support children who experience the death of a brother or sister. The loss of a child shatters assumptions parents hold regarding their role as protector and their beliefs about the natural order of children outliving their parents. A child’s death can cause tremendous upheaval in families as a parent’s overwhelming grief pulls them away from their surviving children, often leaving siblings alone to deal with their own grief. Children and teen siblings grieve a unique relationship, one of friend and foe, a companion that will travel alongside in life’s adventures. After a sibling death, children and teens may question their own importance, wondering, “Am I not enough?”  

Jana talks with Erin Shuster about the death of her brother from suicide. A former young adult group participant and volunteer, Erin talks openly about the unique aspects of grief when someone dies of suicide and how she learned to identify her needs and advocate for herself. 

For information about our groups for young adults, visit: http://www.dougy.org/grief-resources/help-for-young-adults/

Jana and Joan Schweizer Hoff talk about navigating Father’s Day while grieving. Joan, a long-time staff member at The Dougy Center, shares both personal and professional experiences in constructing new ways to approach the holiday. Whether you’re grieving the loss of a father, or parenting a child who is,  some of these suggestions may be helpful:

• Know that for many, the lead up is the worst part.

• If you are supporting a grieving child, talk with them ahead of time about what they would like to do or not do.

• Let children know that it’s okay to still want to celebrate and it’s okay to not want to celebrate. Don’t force a child to pick another adult to honor, unless that’s something they want to do.

• If you are a grieving parent, consider whether and how you want to engage with the holiday - perhaps you recreate a tradition you shared with your child or do something new for yourself.

• Come up with a plan - even if that plan is to do nothing. If you do want to do something, consider doing something that connects you with who the person was and what they meant to you.  

• Consider a social media fast for the day - or - plan what you want to post.

• Identify others in your life who feel fatherly - and - it’s okay if you don’t feel this way towards anyone. Don’t pressure yourself to put someone in that role if it feels inconsiderate, impossible, or dishonoring of your father.

• Plan something for yourself - hike, brunch with friends, a trip out of town. …. decide what environment you want to be in, knowing that you are likely to run into dads and families.

• Get together with others who are grieving.

• Focus on a category - say food, movies, activities, color, or music - choose a few from one or all the categories that your dad or child loved. If you don’t know, and many people don’t, go with your best guess or pick the ones you love.

• Volunteer - doing for others can often take us out of our own experience and create a sense of contribution, belonging, and connection.

Jana and Donna Schuurman discuss terms to avoid, and what to say instead, when talking about suicide. Here is a link to download our Tip Sheet on how to support children and teens who have had someone die of suicide.

Terms not to use (and why):

1. “Committed Suicide”

Committed suicide,’ with its implications of criminality, is a carryover from the Middle Ages, when civil authorities, finding the victim beyond their reach, punished the survivors by confiscating their property. Victims were forbidden traditional funerals and burials, and suicide was considered both illegal and sinful by the laws and religions of the time.

2. “Completed Suicide” or "Successful Suicide"

These terms make it seem like something to celebrate: He completed this! She was successful!

3. “Suicided”

We don't say someone "cancered" or "car accident-ed"...

4. Using "suicide" as a noun (as in "he was a suicide") 

This reduces the person to the mode of their death. 

Better terms:

1. Died by Suicide

The Compassionate Friends was the first to officially adopt the terms ‘died by suicide’ or ‘died of suicide. ’

2. Died of Suicide 

Here's a general Rule of Thumb: If you can’t substitute the word “Cancer,” you may want to reconsider how you're using the word "suicide." He died of cancer: He died of suicide.

3. State how the person died (jumped off a bridge; took an overdose); of course, this is the personal preference of family members, something not all will choose to do)

4. “Suicide Death”

 Advocated by the Canadian Association for Suicide Prevention. (Some find it repetitive in that suicide IS by definition a death. (Whereas, for example “cancer” by definition does not always mean a death.)

Jana talks with Jenna, a participant in The Dougy Center's group for young adults, about the experience of losing her mom when she was a child and then her father, just before the start of her senior year at college. 

For information about our groups for young adults, visit: http://www.dougy.org/grief-resources/help-for-young-adults/

Other great resources for young adults who are grieving:

Websites

www.modernloss.com

www.whatsyourgrief.com

Books

Wild, by Cheryl Strayed

A Heartbreaking Work of Staggering Genius, by Dave Eggers

The Long Goodbye, by Meghan O'Rourke

Tips for grieving through Mother’s Day

• Whether you want to acknowledge the day or want to ignore it, know that the lead up, for many people, is the worst part. It can help to make a plan for the days leading up to Mother’s Day.
• If you are supporting a grieving child, talk with them and their teacher ahead of time about possible activities at school. Work with the teacher and the child to come up with alternatives and options. 
• Let children know they can still celebrate Mother’s Day - and that it’s okay if they don’t want to. Don’t force children to pick another adult to honor, unless it’s something they want to do. 
• Know that there will be an inundation of advertisements in many places. If needed, come up with some strategies to navigate shopping and social media. 
• Consider a social media fast for the day - or - plan what you want to post. Maybe choose a favorite picture and think ahead about what you want to write. 
• Identify other women in your life you would like to celebrate- and - it’s okay if you don’t want to. Don’t pressure yourself to put someone in that role if it feels inconsiderate, impossible, or dishonoring of your mom. 
• Plan something for yourself - massage, hike, brunch with friends, etc. Decide what environment you want to be in, knowing that you are likely to run into moms and families.
• Get together with or reach out to others who are grieving the loss of their mom. 
• Focus on a category - say food, movies, activities, color, or music - choose a few from one or all the categories that your mom loved. Plan part or all of the day to do something with those elements. Maybe it’s eating a favorite meal while watching a loved movie and wearing their favorite color. This is a great one to include children. 
• Volunteer - doing for others can often take us out of our own experience and create a sense of contribution, belonging, and connection. 

After a death, it’s not unusual for children to have an increased sense of fear and anxiety. (It’s not unusual in adults, either.) When bad or sad things happen, it’s natural to be afraid more bad things will happen. The questions and concerns are normal: How will we live without the person who died? Who will take care of me?  Will someone else die? Where do people go after they die?  Will I die too?

There's PDF tip sheet included with the podcast. The tipsheet can also be found here: http://www.dougy.org/docs/TDC_Fears_Tip_Sheet_10_14.pdf

Losing and finding yourself in grief.

Brendon and Jana delve into the many layers of loss that we grapple with when someone dies and how that loss can change us. When we grieve, we miss the person and who they were in our lives. We miss who we were with them. Often we miss who we were in general before the death. As we think towards the future, we grieve for the events and occasions that we won’t share with the person.

Over time, people in grief may start to see themselves differently. What they value, prioritize, and want in life can change radically.

These changes occur on many levels:

• Spiritual shifts
• Difficulty remembering/accomplishing small tasks.
• Want to be social/difficult to be around people
• More compassionate/less able to tolerate everyday drama
• Put more time and energy into relationships
• Less concerned with work and material success/more immersed in work
• Can’t seem to exercise/exercise all the time – need it
• Increased interest in movies/books/songs about grief – vs. can’t tolerate them at all

As you sort through what is different, it can be helpful sit with a series of questions:

• How do you see yourself now?
• How do you see the world?
• Which of these changes do you value?
• What strengths have you discovered?
• Where are the places in your life that you need additional support?
• What parts of yourself do you miss and want to re-cultivate?

Here is a related article on The Dougy Center web site.

"The language we use to describe events not only reflects our own attitudes but influences those attitudes as well as the attitudes of others."

--Sommer-Rotenberg, D.

Donna Schuurman, Senior Director of Advocacy and Training at The Dougy Center discusses some of the difficulties of language and stigma surrounding deaths by suicide.

Understanding And Supporting The Grieving Teen

If you know a teen who is grieving a death, you may wonder what responses or behaviors you can expect to see and how to help.

Grief is a holistic experience

Grief can affect teens in many different ways: emotionally, behaviorally, cognitively, physically, and spiritually. The following are examples of how grief might look in these realms. Keep in mind that this list is just a sample of the indicators: 

Emotional: Every emotion imaginable can be associated with grief. The most common ones include sadness, anger, confusion, fear, agitation, depression, relief, apathy, joy, restless, guilt, regret, irritability, yearning, increased appreciation, and gratitude. 

Behavioral: Dropping activities/hobbies, difficulty sleeping, clingy behavior, regressions, aggression, withdrawal, nightmares, diminished/increased performance at work or school, decrease/increase in social engagement, substance use, over-planning/scheduling of activities.

Cognitive: Difficulty concentrating/confused thinking, forgetfulness, difficulty completing tasks, memory loss, narrowed scope of thinking, intrusive/repetitive thoughts, easily overwhelmed.

Physical: Loss of appetite, weight loss/gain, increased frequency of colds/flu, stomachaches, headaches, and nausea.

Spiritual: Questioning or loss of faith, anger at God or other higher power, strengthening of faith, questioning values, rethinking the meaning of life and/purpose. 

So what does this look like in day to day life?

• Grief can make everyone forgetful. Teens may need extra reminders about chores and plans. 
• School can become very challenging. Engage with teachers and administrators to help support teens. 
• Teens may be less able to modulate their emotions and have more frequent outbursts and easily feel overwhelmed.
• Some may grow distant, turning more to peers for support.
• May see swings of maturity as teens move between feeling like a six-year-old one minute and then speaking with the wisdom of an elder the next.
• Push/pull of emotional availability. They may want hugs one moment and then retreat to their room the next.
• Teens can take on additional fears and concern about how the family is doing in terms of financial security. May have questions about their future based on these changes.
• Strong feelings of wanting to feel and be seen as a normal teen. “I don’t want to just be that kid whose dad died.”
• Dislike sympathy, but appreciate acknowledgment of what has happened. 

Needs of Grieving Teens and Ways to Support Them

1. Assurances: Grieving teens need supportive and available adults in their lives. Reassure them that grief is unique and that there is no one right way to grief. Knowing that grief isn’t something they have to “get over,” but that it will change over time, can also be comforting. 
2. Boundaries: Reasonable and consistent boundaries provide safety and support during a time of disorienting change.
3. Choices: Teens are empowered when they have options and their choices are honored and respected.
4. Food, water, and sleep: Grieving takes a lot of energy, so it is important for teens to have nutritious food, hydrating drinks, and enough sleep.
5. Listeners: Not knowing what to say can leave us filling in the blanks with advice and words designed to make teens feel better. Practice listening and asking questions, allowing teens to talk and be heard. 
6. Models: Teens look to the adults in their lives to provide examples for how to grieve and express their emotions. Molly story
7. Privacy: Much of the grieving process is private including reflection, emotion, evaluation, and memorializing. Kelina story
8. Recreation: Grieving teens need “breaks” and chances to play, laugh, and be active. More than just their death. 
9. Routines: These create consistency so that teens do not have to constantly worry about what will happen next. Remember also to be flexible about your expectations.
10. Truth: Grieving teens appreciate truthful information related to the death and potential changes in their lives.

For more info, see our guidebook, Helping Teens Cope with Death, or the DVD Helping Teens Cope with Death.

Where did everyone go? How grief affects connections with family and friends. 

This episode grew out of a few questions from the community – 

1. Why is it common for communication to either lessen with family/close friends or strengthen after a mutual loss?
2. Why is it easier to connect with strangers?
3. In my family we don't talk about the person - How do I know if I can bring it up? How do I bring it up?

Grief affects our connections with others in many ways. Loss can foster a greater closeness with family and friends and it can also wreak havoc on existing relationships, leaving people unsure and disappointed. Many factors contribute to changes in relationships, particularly the role that the person who died played in your family and friend constellation. For some grieving people, especially children and teens, it can feel more comfortable talking with those they aren’t close to, including those who didn’t know the person who died. 

Suggestions for ways to make it easier to talk about the person who died in your family: 

• Let people know that you want to talk about the person. 
• Reassure them that talking about the person is helpful, even if you get emotional. 
• Provide suggestions for responses that you find helpful and those you don’t: “I like when people use his name. I don’t like when people tell me not to feel guilty.”
• Start a conversation about creating a ritual at family gatherings to include the person who died. 
• Examples include: set a chair or plate at the table for the person, invite people to bring favorite photos and create a family photo board, take videos of family members sharing memories of the person. 

Valentine's Day is one of the many holidays that shift and change while grieving. As with so many other holidays, the lead-up can be really hard. Advertisements and casual conversations about plans can leave grieving people left out, or eager to flee.

In this episode of Grief Out Loud, Jana and Brendon talk about strategies for approaching Valentine's Day in a way that opens up space to express love and appreciation.

Some ideas mentioned in this episode:

• Decide on what traditions you and/or your children want to uphold and then figure out who will be responsible for what.
• Connect with others you find to be supportive - this might look like setting up a phone call, email chat,  or getting together for dinner.
• Schedule some self-care that feels replenishing: go for a hike,  check out a new movie, take a yoga class, meet up with friends,  journal, or cook a nourishing meal.
• Ask your kids what helps them feel energized or calm - we sometimes forget that kids need self-care too.
• Volunteer for an organization or event that is meaningful to you.
• Send cards, flowers, or an email to friends and family who might also be going through a hard time.
• If it feels right, create a ritual or activity connected to the person who died. Ideas include, make a meal they enjoyed, go to their favorite restaurant, make or buy a card for them.
• Many kids like to bring something - card, flowers, balloons, to the grave site. If there isn't one, you could put them where you keep the ashes or visit the place where the ashes were spread. Or if that's not possible, display an image of that place.
• Write a card or letter to the person who died. You might write about: events you want them to know about (your son's first soccer game, a promotion at work, a description of a sunrise you recently saw, etc), things you are grateful to them for,  ways in which you and your family have grown or changed, or anything that comes to mind. You can keep, bury, or burn what you write.

Whatever you decide, go easy on yourself. There can be so much pressure, both internal and external to think or feel a certain way. Know that it's okay to feel whatever you feel (sadness, anger, numbness, irritation, etc), leading up to and on the actual day.

Alternatives to “I’m sorry for your loss.”

This episode delves into that moment when you find out about a death. Most of us don’t know what to say or do, so we go turn to what we’ve heard others say in a similar situation, “I’m sorry for your loss.” While there’s nothing wrong with those words, especially when said with authenticity and full presence, it’s helpful to know how that phrase affects those who are grieving and what you can say instead. Whether it’s getting a phone call with the news, writing out a sympathy card, or learning about a loss during a casual conversation, everyone encounters the dilemma of what to say and how to communicate we care.

Alternatives

• “I was so sad when I heard the news about your mom’s death.”

• With children and teens, they appreciate an honest: “That totally sucks.”

• If you do go with “I’m sorry” expanding it to “I’m so sorry you have to go through this,” or “I’m so sorry this is happening.” can break up the monotony of “I’m sorry for your loss.”

If you’re talking with someone, try reflecting back what they’ve said, allowing them to say more:

• “Your dad just died last night.”

• “Today’s the anniversary of your sister’s death.”

When writing a sympathy card or email:

• Consider sharing a specific memory of the person who died: “I remember so clearly your mom’s smile, it made me feel so welcome.”

• “There are no good words, just want you to know you are on my mind and in my heart.” can acknowledge that words don’t always measure up in times of grief.

“How do I tell my child about the death?” This is the most common question we receive at The Dougy Center. Someone has died, leaving parents and other adult caregivers to struggle with finding the right words to say to their children. In this episode, we outline tips for talking with children about a death. Adults can start by attending to their own reactions to the death. Often the thoughts and feelings they experience can impede or enhance having an open, honest, supportive conversation with their children. As an adult, what do you need to sort out with feeling shame, blame, confusion, guilt, or other emotions related to how the person died? How can you keep that as your story and not put it onto your children?

Summary of tips for talking with children:

• Tell the truth
• Use concrete, age-appropriate language
• Allow for questions - in the moment and over time
• Be prepared to tell the story over and over, esp to younger kids
• Refer to The Dougy Center resources (below)
• Know that you are providing children with a safe, trusting foundation from which to experience their grief 

Bookstore: http://tdcbookstore.org

Tip sheets: http://www.dougy.org/grief-resources/tip-sheets/

Main site: http://dougy.org

In this episode, Jana and Brendon, answer two questions from the community. The first is from a mother of two young children who wonders what she can do with the ashes of her partner. The second from a young adult struggling with whether they should go to the funeral of a close friend’s mother. In this frank conversation, we discuss common and not so common options for what to do with ashes and outline some foundational questions to consider, both for adults and children when deciding.  

Two resources with ideas for what to do with the ashes of someone who dies:

• A long list of options for ashes from Mental Floss
• Another list of 27 options for ashes from Urns Online

In this episode of Grief Out Loud, Jana and Brendon discuss some of the current mythology surrounding grief timelines. We demystify the idea that there is a recipe for grieving or one right way to go about integrating a loss. Listen to learn new ways of conceptualizing the unfolding of grief. During the discussion, Jana mentioned a couple of relevant resources:

1. Getting Grief Right, a NYT Opinionator article about grief timelines and "stages of grief"
2. 5 Stages of Grief overview, which Jana noted is a familiar cultural landmark, but not a framework that The Dougy Center endorses for those who are grieving. While each of the stages involves thoughts and feelings that grievers may experience, it’s not a clear-cut linear process. Thinking that we need to achieve certain stages in order to grieve correctly can often create more suffering for those in grief.

In this inaugural episode of the Grief Out Loud Podcast, Jana and Brendon introduce themselves, talk about the history of The Dougy Center, and our work with grieving children and their families. Jana and Brendon also do a little housekeeping with respect to episode timing (weekly) and duration (aiming for 15-20 minutes), as well as what TDC can offer to the podcast community.

Resources mentioned in the show:

1. The Dougy Center for Grieving Children and Families