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Posts Tagged ‘
suicide ’
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Introduction |
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Explaining Suicide to a Child – John’s Story |
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Child and Adult Grieving Differences |
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How Children Grieve at Different Ages |
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Should Children Attend the Funeral or Memorial Service? |
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Explaining Cremation |
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What to Say and Do |
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What Not to Say and Do |
Introduction
Children today have a familiarity with death, at least as an abstraction. They witness deaths on television, in movies, and in music. While death today is not often present in the home (as it was when it was more common for elders to die at home), children are aware of death in hospitals and of pets dying.
Discussing death with children is important, although doing so may be uncomfortable for adults. Children need to be told the truth in a straightforward manner and in a way that is age-appropriate for the child.
John’s father committed suicide when John was ten years old. His mother quietly said to him, “You know that Dad has been feeling very sad lately. This morning he took his life. He committed suicide.” By knowing the real situation, John could work through his feelings about his dad’s death. He felt free to ask questions and receive answers he could understand. Answer children’s questions directly, without a great deal of detail. Children who receive accurate information do not have to imagine the worst.
You must be careful with the language you use when discussing death with children. Terms such as asleep, passed on, passed over and gone on a journey are potentially dangerous for children who take such words literally. Imagine a child being afraid to go to sleep because sleep is synonymous with death.
Children grieve differently than adults. While children share the same grief emotions as adults, they often express them differently. For example, an adult may be able to express anger verbally, while a child may do so through drawing pictures. Children also grieve in spurts. One minute a child can be sad and crying in his room, and the next he’s outside happily playing baseball. Children at each age grieve differently from other ages. Outlined below is how children in different age ranges view death; however, keep in mind that factors other than age influence how a child grieves: intelligence, previous experience with death, family environment, religion, and culture also determine grief behaviors in children.
- Three to Five Years Old. Children at this age often think death is reversible. Magical thinking is common. If the princess can awaken from a long sleep, so can grandfather awaken from death. It is important to tell children that death is permanent, and that their loved one will not come back.
- Six to Ten Years Old. By this age, children understand that death is final. They begin to realize that they, too, can die. They need to be told that just because a loved one died, they are not necessarily going to die. Children in this age range are media-savvy and are aware of murders and kidnappings committed against children. They need to be made to feel safe and protected. They need simple, honest information.
- Eleven to Thirteen Years Old. Children in this age range have a realistic view of death, but refuse to believe death can happen to them. They share adult grief emotions, but often are overwhelmed by these feelings. They tend to move in and out of grief.
- Teenagers. Teenagers may either internalize grief or act out grief emotions in inappropriate or dangerous ways. Those who internalize grief may lead adults around them to think they are handling grief well. Look for grief emotions to sneak out, expressed in poetry, art, and music. Some teenagers act out their grief in destructive ways, such as driving recklessly, fighting in school, experimenting with drugs and alcohol, and engaging in sexual behaviors. Regardless of how a teenager grieves, help from an adult is needed. If grief becomes pathological, seek counseling with a trained mental health professional.
If a child is old enough to express his desire to attend, let him do so. Attending the service may help the child understand the finality of death, and may assist him in celebrating and mourning the death of a loved one. Explain to the child in advance of the service what he can expect to see and hear. Tell him you will be there to hold his hand.
If a child states that he does not want to attend, do not force him. Be sure, however, that the child has all the facts about the service, and pay attention to any fears the child may express. You can offer to visit the cemetery with the child later.
Cremation is often more difficult to explain to a child than burial. Keep your explanation simple. Do not use words such as fire and burn, which may frighten the child. Explain that the body was taken to a crematory where it went through a special process so that it was reduced to something that looks like sand. Mention that the ashes were put in a container called an urn, and then explain what the family plans to do with the urn.
If you are a friend to a child who is grieving, there are many ways in which you can help the child process emotions. Listed below are some things to do or not do.
- Keep routines as normal as possible.
- Say the deceased person’s name.
- Talk about the person who died. Keep memories alive by looking at photos, recognizing holidays and anniversaries, and commemorating the person.
- Provide the child with opportunities to express feelings. These feelings may include guilt, anger, sadness, confusion, or anxiety. Listen and give your support to the idea that it is acceptable to express emotions.
- Be patient and adjust your behaviors to fit the child’s needs.
- If a child becomes aggressive, try to channel his behaviors so that he understands what behaviors are acceptable, what behavioral limits are, and that he is cared for and safe.
- Share your feelings with the child. If you cry, explain your sadness to the child.
- Model appropriate grief behavior. Express your own emotions in a healthy way.
- Avoid euphemisms such as passed away, gone on a journey, and asleep. Children may take these terms literally. Be honest.
- Do not say, “God loved your mother so much that God sent her to heaven.” A child may feel that he, too, may die if he is good.
- Do not say, “It was God’s will.” Regardless of what you as an adult believe about spirituality and death, such a statement may negatively shape a child’s view of God and spirituality.
- Do not say, “It was best your mother died because she is no longer suffering.” Perhaps a child would rather have a suffering mother than none at all.
- Do not say, “You’re the man of the house now.” The child is still a child, and should not be saddled with adult responsibilities. Also, the child cannot take the place of someone who has died.
- Do not say, “You must be brave” Children do not have to be brave. They should be allowed to express emotions, and to know that such expression is acceptable. Do not say, “You’re doing so well” (if the child is not expressing emotion). Saying this may tell a child expression of emotions is not acceptable.
- Do not say, “You should be better by now.” There is no timetable for grief.
- If a child’s behavior becomes regressive, do not criticize the child. Regressive behaviors such as bed-wetting, and thumb-sucking are common after death.
The book A Good Friend for Bad Times: Helping Others Through Grief, by Deborah E. Bowen, MSW and Susan L. Strickler is published by Augsburg Books and is available at www.augsburgbooks.com. It is also available at other Internet book retailers and at local bookstores.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Introduction
Certain illnesses and circumstances surrounding death require special considerations by friends and coworkers of those grieving. While the stages of grief are the same, particular issues may need to be addressed and unique comforts given with different circumstances.
Alzheimer’s disease is the most common form of dementia, affecting people of all ages, races, religions, economic status, and ethnicity. Its course is unpredictable.
Sue's Story
The patient has days of mental clarity when a plateau is reached, and days of total confusion. Sue’s mother began her descent into Alzheimer’s disease slowly. At first, she got lost going to familiar places. She wrote notes to herself constantly, including listing her sisters’ names. She became suspicious of people, was less spontaneous, and progressively lost interest in former activities. She began to hide possessions, particularly dinner forks and shoes. Later, she could no longer recognize friends and family. Near the end of her life she stopped eating and remained in bed in a fetal position.
As the illness progresses, caregivers of Alzheimer's disease patients find their experience also to be progressively difficult. They have most (if not all) of the anticipatory grieving emotions during the process of the illness. They may feel angry, sad, guilty (“I want my life back, and I feel guilty about wanting it when she’s so sick.”), discouraged, irritable, or exhausted (“I can’t get any sleep. She wanders all night.”). Folks who have not experienced caring for a person with Alzheimer's disease cannot understand how overwhelming this caregiving job is. Caregivers often feel alone and isolated in their roles.
Unfortunately, one of the by-products of caregiving for an Alzheimer's disease patient is that the caregiver loses contact with friends and outside activities. Both friends and other family members may withdraw from the caregiver. Sometimes this withdrawal initiates from respect for the caregiver’s time and energy. Sometimes it stems from a lack of understanding: “She must be so busy; she doesn’t want to talk to me.” The caregiver may initiate the withdrawal because she simply does not have time to focus on anyone except the patient.
Because Alzheimer's disease is such a slow, progressive illness, anticipatory grieving can last for years. Also, the grieving needs of the caregiver may be stronger before death than afterward, and support from friends is vital during this time. Be aware, also, that after losing a patient to death from Alzheimer's disease, the caregiver may experience a tremendous void in her life, as well as a loss of direction and meaning. She still must deal with grief after death. Those same grieving stages that occurred before death will reappear. They may be couched in a different framework, but they still must be addressed. Your friend needs you during both phases of her grief.
- Offer to stay with the person with Alzheimer's disease so your friend can get out and do something for herself. If she cannot think of any activities, suggest a walk, a movie, or a religious ceremony.
- Prepare a meal. Try to organize a group of supporters so that a meal or two can be delivered each week. Make large portions so some can be frozen for another meal. Offer to feed the person with Alzheimer's disease.
- Clean the house, do laundry, change linens, wash windows. Ask your friend if there is a particular task that needs addressing.
- Run errands.
- Pay for occasional respite stays in an adult care center. Transport the patient to appointments or to an adult care center (if used).
- Help install special locks on doors.
- Order identification bracelets.
- Provide gift certificates to encourage self-care for your friend. Suggestions include certificates for a massage, manicure, pedicure, or hairdresser. Then be willing to sit with the person with Alzheimer's disease while your friend is out.
- Call if you cannot visit regularly.
- When you do visit, do not overextend your time, particularly if the patient is having a difficult day. Send inspirational cards or notes saying “I’m thinking about you.”
- Encourage your friend to join a support group. Most cities have caregivers’ support groups.
- Encourage journal writing.
- Allow your friend to vent, to express emotions, concerns, and frustrations.
- Help her cultivate her sense of humor. Create opportunities to laugh.
- Be nonjudgmental. Your friend is doing the best she can. Tell her so.
While there are similarities in grief with all long-term illnesses, HIV/AIDS deserves a special mention because of a concept called “disenfranchised grief.” Disenfranchised grief occurs when the illness or death of a loved one is not acknowledged or socially accepted. Those who grieve losing someone to HIV/AIDS are sometimes denied the opportunity to openly express their feelings and be emotionally supported by friends and family.
The social stigma attached to HIV/AIDS, unfortunately, has not lessened very much over the years since the virus/disease were discovered and named. Society still associates HIV/AIDS with risk-taking behaviors, so those who contract it, and their caregivers, often are often viewed negatively. Fear still plays a large part in the treatment of people living with HIV/AIDS. For example, we have spoken to health care providers who refused to care for patients with HIV/AIDS, and with family members who were afraid to visit their relative because they erroneously think they might “catch it.” (For more information on HIV/AIDS transmission click here to read the NASW HIV/AIDS General Overview.)
Peggy's Story
Peggy said that her son, who was HIV positive, developed cancer, which later was the actual cause of his death. Peggy stated that she believed people were far more sympathetic to her grief with a diagnosis of cancer than they would have been with a diagnosis of HIV/AIDS. “I was so relieved that he got cancer, because I didn’t have to tell anyone he also had HIV.”
HIV/AIDS, like Alzheimer’s disease, is sinister in its progression. We have known persons who had advanced HIV/AIDS that affected their brain and could no longer communicate verbally. We also have known people who have died from this illness without their brain being affected. In any case, the illness can move quickly or slowly, and can create tremendous anticipatory grief for both the person with HIV/AIDS and his or her caregiver.
Insightful therapist Carl Rogers coined the phrase “unconditional positive regard.” Rogers meant that we should hold others in the highest possible regard without demands or stipulations. It means caring without passing judgment. Perhaps with no other population does this concept mean so much as it does with people living with or dying from HIV/AIDS.
The list outlined above for Alzheimer’s disease also can be used here. Follow these suggestions as well:
- Be aware of your own feelings about HIV/AIDS and people living with it. If you are not sincere in your concern and actions, or are afraid, the people you are trying to help will know it immediately.
- Hug the patient and the caregiver. Your willingness to touch people living with AIDS speaks of your caring far more clearly than any words ever could.
- Assist with paperwork.
- Assist with research concerning legal rights of partners.
- Help the patient stay on his or her medication. Talk with the patient about side-effects and how to keep up with a complex medication schedule (if you feel qualified).
- Take the patient for an outing, if he or she feels up to it.
- If there are children, offer to baby-sit so the caregiver or the patient can get out for a while.
- Assist with birthday parties and holidays.
- Provide emotional support. Allow the caregiver and the patient an opportunity to express emotions.
- Listen. After a death, the caregiver needs all the support listed above, but pay special attention to the following: Enable the survivor to tell his story.
- Understand that survivors of someone who has died from AIDS may have strong emotional outpourings, particularly anger, fear, guilt, and shame. Allow your friend to express those emotions. Remember that emotions are not right or wrong. They simply are.
- Your friend may have feelings of abandonment, both by the deceased person and by friends and family who, for whatever reason, were not present during the illness and death. Allow your friend to express those feelings.
- Be patient. Remember that grief has peaks and valleys, and is a roller coaster. Give your friend time and space. Remember birthdays, anniversaries, holidays, and death days. Perhaps you and other friends and family members could assist in planning and carrying out a special ritual or memorial service on these days.
- Do not avoid the grieving person.
- Do not be judgmental.
- Do not avoid mentioning the name of the deceased.
- Do not get involved with family conflicts.
- Do not load up your friend with “shoulds.” You have no right to tell her what she or he needs to, or should, do or not do.
According to the National Institute of Child Health and Human Development, National Institutes of Health Web site, about 15 percent of all pregnancies end in miscarriages. Unfortunately, society does not attend nearly well enough to those grieving such deaths.
Some of the most callous comments we have heard in our work have come from well-meaning people to those suffering loss from miscarriages. “You didn’t really know this child because it wasn’t born yet.” “You can have others.” “You should try to get pregnant again right away.” “At least you have other children.” What awful, insensitive statements!
Most often, in an anticipated pregnancy, parents begin to bond with a baby the minute the pregnancy is confirmed. This bonding becomes stronger as gestation progresses. When a miscarriage occurs, grief can be overwhelming. All the stages of grief appear. The mother may also feel that she is a failure because she was unable to bring the baby to term.
Marcy's Story
Marcy miscarried her first child in August many years ago. Every August thereafter she has experienced depression, anger, sadness, and guilt over the life that might have been. Her feelings of loss never leave her.
In a stillbirth, like a miscarriage, a life is ended before it has an opportunity to develop. Also, like in a miscarriage, attempts at comforting the grieving parents can be clumsy at best.
The difference between miscarriage and stillbirth is that in a miscarriage the fetus does not come to term, while in stillbirth a body must be cared for. Parents may choose to have a Baptism or memorial service in the hospital chapel. Some parents find a picture or footprint of the baby comforting.
Remember that your friend not only grieves the loss of the child, but all the events in the child’s life that will never happen (the first tooth, high school graduation, marriage, children).
If you are a friend to someone grieving a stillbirth or miscarriage, some of the suggestions below may be helpful.
- Attend whatever rituals or services your friend chooses to hold.
- Plant a memorial tree or bush for the family.
- Suggest that your friend light a memorial candle on holidays and special days, and participate in the lighting of this candle.
- Suggest that your friend join a support group, such as Compassionate Friends, an international organization for those grieving the loss of children.
- Suggest that your friend keep a journal of her grief work. Remember the anniversary date with a card or a call.
While in theory we believe that all grief is equal, we feel that in reality there is no greater grief than the loss of a child, regardless of the age. Whether the child is a newborn infant or twenty-one years old, all the theories we know regarding grief work seem to be invalid or, at best, inadequate. In our experience, families who have children die never appear to reach the closure stages noted by the experts. Grief experts now understand that a bereaved individual or parent can have an ongoing bond with their deceased child.
Dan's Story
Dan, whose daughter was killed in a car accident, told us, “I learned to get through each day in a fog. I became a robot, doing what needed to be done at work, at home. The sharp, searing pain became a dull ache, which never goes away for a moment. Even as I learned to laugh again, I mourned that I could never laugh again with her.”
We expect elderly people to die. That is the order of nature. Somehow, the death of a young person disrupts this order. Most of us question the reason for death for anyone: “Why did he have to die of cancer? Of a heart attack?” There are, of course, no answers to these questions, but when they are asked about the death of a young person, the void seems bottomless: “Why so young? Why now?”
Often there is tremendous guilt surrounding the death of a youngster, regardless of the cause of death. The “if onlys” and the “what ifs” are endless.
April's Story
April’s daughter left home at sixteen, living on the road, calling home occasionally, and usually coming home for Christmas. At twenty-eight, she was found dead of a heroin overdose. April’s anguish was inconsolable. “I wish I could have locked her in her room until she was thirty, keeping her safe. If only I had been more aware of her drug problem . . . if only I had tried to stop her . . . if, if, if.” The answer is that there are no answers.
Beth's Story
Beth’s daughter died at age ten of leukemia. The years of treatments, the false promises of periods of remission, and the final acceptance of the illness took their toll on the whole family. Beth and her husband found themselves grieving the loss of their daughter differently from each other. Beth cried and wailed, while her husband maintained a stoic silence. The loss of a child can bring family members close to each other, or it can rip a family apart. Beth’s mother said, “Why did she have to die? Why couldn’t it have been me? I’m old and ready to go.” Again, there are no answers.
Use any of the suggestions mentioned earlier in this article, as well as the following:
- Listen . . . again and again and again. Your friend needs more than anything to talk about the child. She needs to tell stories about his life and to mourn all the events that will never be.
- Say the child’s name. Doing so validates his life. Remember anniversary dates with a card, a telephone call, or a visit.
- Honor the child with a memorial gift to a foundation or organization (such as a school, church, etc).
- Create a living memorial by planting a tree, giving books to the local library (or his school library) in his memory, or donating playground equipment to his favorite park.
According to suicide researcher and author Beryl S. Glover, suicide can be one of the most tragic forms of death. It is almost impossible to predict. According to the Centers for Disease Control, in the year 2000 alone, 29,350 lives were lost to suicide in America.
Suicide rates are especially high among the elderly, but often are misdiagnosed. Many elderly people suffer from chronic physical illness and cannot tolerate the loss of independence and self-sufficiency. Elder suicide often has been ruled as unintentional drug over-dose. Fortunately, medical professionals are becoming more aware of the growing trend of elderly depression and suicide, and are taking measures to help.
Suicide patterns have changed among young people recently, and attempts have risen dramatically. Suicidal adolescents, like suicidal adults, may be deeply depressed, but signs are sometimes difficult to recognize because they may manifest themselves as boredom or physical complaints.
There are many reasons people commit, or attempt to commit, suicide, but that discussion is beyond the scope of this article. However, it is important to note that any suicide attempt or threat should be treated seriously. If you suspect that a friend or coworker is planning a suicide attempt, seek professional assistance immediately.
The stigma of this type of death can entail more shock and denial than many other kinds of deaths. Survivors of a suicidal death certainly experience all the stages of grief, but they often have a prolonged period of numbness, so that there appears to be an absence of feeling.
The suicide survivor has the right to feel (or not to feel) any emotion after the death of a loved one. She may feel shame, guilt, or disbelief: “Why didn’t he leave me a note?” She may blame herself: “What did I do wrong?” “Could I have prevented it?” She also may feel anger or a sense of relief that the person no longer suffers from mental or physical illness.
Suicide survival can be thought of as another kind of disenfranchised grief, one not generally discussed. This often results in a lack of emotional and social support for the survivor. Fortunately, this stigma is changing, and the pain felt by the survivors is becoming more easily acknowledged.
- Encourage your friend to talk about her feelings. Help your friend deal with “unfinished business” (i.e., finding a way to say good-bye).
- Be careful about being judgmental. Avoid clichés.
- Allow your friend to cry, scream, or express emotions in any way. Be aware of potentially intense feelings. Help your friend to laugh and to celebrate the life of the deceased person.
- Encourage your friend to join a support group. Most cities have such groups for suicide survivors.
- Understand the uniqueness of suicide grief.
The death of a pet can be traumatic for both children and adults. Pets love unconditionally. They ask for little in return for affection and companionship. Fortunately, society is beginning to accept the reality of the grief felt when a pet dies.
Deb's Story
Deb lived for eighteen years with Merlin, the Magic Cat. He was her constant companion, loving to ride in the car, walk on the beach, and even ride in her boat. When he died, it was as if her best friend had died. Merlin also was special to many of Deb’s friends, and some of them were with Deb and Merlin in his final hours. Friends and family brought food and attended a memorial service honoring his life. Merlin was cremated, and Deb’s friends helped her scatter his ashes. A friend painted a portrait of him from a photograph. Her employer granted her three days of bereavement leave from work.
Grief over the death of a pet is no different from grief over a person, although the grief varies in intensity from person to person. One can experience all the emotions common to grieving the loss of a person, including anger (particularly if the pet was killed) and guilt (“I should not have left her outside”). It is important to note that each member of a family has a unique relationship with a family pet, and each relationship should be honored, including the variety of emotions that various family members may feel at any one given time.
Children should be involved in any rituals and memory sharing regarding a pet. If the decision is made to euthanize the pet, children should be informed beforehand, so that they can have their special time to say good-bye.
Older adults often have special relationships with their pets, particularly if they live alone with the pet. Sometimes the death of a pet can bring up old feelings regarding the death of a loved one, resulting in compounded grief.
Certainly, all the suggestions in this article regarding the death of any loved one can apply to the death of a pet. However, below are some special considerations:
- Be careful regarding how you express sympathy. Treat the death as you would any other loss. Do not minimize the death in any way. Do not say, “You can get another cat.” “I know someone who has a dog just like yours and she just had puppies.” “At least you can go out now without worrying about the dog.”
- Telephone, send a card, or visit.
- Offer to frame a special photograph of the pet. A friend who recently lost a pet was given a beautifully framed poem about, and photo of, his cat.
- Present your friend with an ornament or statue that symbolizes his relationship with his pet.
The book A Good Friend for Bad Times: Helping Others Through Grief, by Deborah E. Bowen, MSW and Susan L. Strickler is published by Augsburg Books and is available at www.augsburgbooks.com. It is also available at other Internet book retailers and at local bookstores.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: alzheimer's, caregiver stress, coping, Deborah E. Bowen, grief, loss, miscarriage, pet, suicide
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Teenage Suicide Warning Signs
The National Association of Social Workers views the current high rate of child and adolescent suicide as a national tragedy. Young people with the following risk factors may be at risk:
- Genetic susceptibility
- Previous family history of suicide
- Depression and other mental health problems
- Impulsivity
- Learning disabilities
- Physical and sexual abuse
- Demographic pressures
- Social changes
- Unwanted pregnancy
- Sexual identity issues
- Drug use
- Disrupted family relationships
- The role of pop culture, including music and television
- suicide clusters and contagion
- The availability of lethal weapons
Here are some of the possible warning signs of suicide. They indicate that a young person may be feeling overwhelmed, hopeless, angry, or depressed.
- Dramatic personality changes
- Relationship problems with intimate friends, parents, and other relatives
- Sadness or depression including loss of appetite, problems sleeping, low energy or poor concentration
- Extreme anxiety or feeling of panic
- Problems in school, frustration and/or disappointment over performance
- Boredom or indifference
- Major health problems
- Aches and pains that have no apparent medical cause
- Rebellious, aggressive, irritable or destructive behavior
- Careless personal hygiene
- Substance abuse (including alcohol)
- Writing notes about death or glorifying suicide
- Giving away or selling valuable or cherished possessions
Sources: NASW publication Social Work Speaks, January 31, 2003, and www.notmykid.org
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Survivors of Suicide Support Groups
Each year, 180,000 people in the United States lose a loved one to suicide. Parents, children, siblings, friends, and spouses are left with complex feelings of grief. They may also be embarrassed by what happened ashamed, guilty, and alone. Historically, many religions viewed suicide as a sin. However, during the late 20th century, thoughts on suicide shifted both religiously and legally. Today, suicide is usually seen as part of an illness related to an individual's internal struggles.
Many communities have begun coordinating survivor groups. According to the Jewish Family and Community Service (JFCS), groups for survivors of suicide help participants in many ways. They provide a community of support to help manage the difficult grieving process felt by survivors. Participants know they can share their stories and details of their loved one's death without pressure or fear of judgment and shame. Survivors realize they are not alone and feel less isolated and ashamed by the loss when they attend these meetings.
Groups offered by JFCS, for example, are usually co-led by a social worker and a lay leader who is a survivor of suicide. The lay leader helps participants share openly by example. Lay leaders also demonstrate that a survivor can go on and heal even though their lives are changed forever. As one survivor said, "The group is a safe place…to share your feelings without the sense that you are being judged or pitied or that people are uncomfortable in your presence."
Participants in varying stages of their grieving process attend the group. Those who have recently suffered a loss come to a group hoping for a little relief from the intense pain they are experiencing. Sometimes participants attend a group long after the death of a loved one. They come to revisit their feelings and understand the impact of the suicide on their current lives.
A 28-year-old man in one group, whose father died when he was 13, attended a JFCS survivor of suicide group. When his father died, the man's mother had told him never to tell anyone outside the immediate family that his father had killed himself. The man respected his mother's wishes but had recently begun to feel dishonest in close relationships. After the survivors' session, the man decided to share details of his father's death with his girlfriend. He was relieved that telling the truth did not change his relationship, as he had feared. He proudly shared the breakthrough with the group the following week.
Professionals who lead these groups say they are touched over and over by stories, such as this one, and admire the strengths of the people who attend their workshops.
The LOSS Team
Most referrals for survivors of suicide groups come from physicians or nurses who share the information when the death is pronounced in a hospital. Unfortunately for many, a hospital is never involved, so that survivors do not receive a referral from a doctor or nurse. Even when resources are available in communities, there is a long time between when the suicide occurs and the survivor gets help. Unfortunately, the survivor may not know about services and those offering the services do not know about the survivors. One study showed that average length of time between the suicide and the survivor seeking an assessment was 4.5 years.
In 1997, a group in Baton Rouge, Louisiana was formed to help survivors of suicide find the resources they need. The group was named the LOSS (Local Outreach to Suicide Survivors) Team. The team is made up of trained suicide survivors and Baton Rouge Crisis Intervention Center (BRCIC) staff. They go to the scenes of suicide to spread information about resources and to be the breath of hope for the grieving survivors. The goal of the LOSS Team is to let suicide survivors know that resources exist as soon as possible following the death.
Survivors have proven to be important resources at the scenes of suicide. Their volunteer involvement contributes greatly to the entire project. They work as peer facilitators in weekly survivors groups, participate in survivor assessments, serve as members of the agency speakers bureau, and mentor new team members.
Since the LOSS Team began responding in 1998, team members have been recognized for their contributions to the newly bereaved in Baton Rouge. The team is working on changing the legacy of suicide for survivors. In September 2004, a documentary was produced by the Discovery Channel to highlight the stories of several survivors and staff of the BRCIC. The program was created to show what it is really like to get help and reduce the chance of another suicide in the future.
To learn more about resources available, please visit the Baton Rouge Crisis Intervention Center Web site at www.brcic.org
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American Association of Suicidology
The goal of the American Association of Suicidology (AAS) is to understand and prevent suicide. AAS promotes research, public awareness programs, public education, and training for professionals and volunteers. In addition, AAS serves as a national clearinghouse for information on suicide.
www.suicidology.org
National Mental Health Association
The National Mental Health Association (NMHA) is the country’s oldest and largest nonprofit organization addressing all aspects of mental health and mental illness. With more than 340 affiliates nationwide, NMHA works to improve the mental health of all Americans, especially the 54 million people with mental disorders, through advocacy, education, research and service.
www.nmha.org
National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline's mission is to provide immediate assistance to individuals in suicidal crisis by connecting them to the nearest available suicide prevention and mental health service provider through a toll-free telephone number: 1-800-273-TALK (8255). It is the only national suicide prevention and intervention telephone resource funded by the Federal Government.
www.suicidepreventionlifeline.org
TeenScreen Program
The Columbia University TeenScreen Program is a national mental health and suicide risk screening program for youth. The goal of the National TeenScreen Program is to make voluntary mental health check-ups available for all American teens. TeenScreen works by assisting communities throughout the nation with developing locally operated and sustained screening programs for youth. Screening can take place in schools, doctors’ offices, clinics, youth groups, shelters, and other youth-serving organizations and settings.
www.teenscreen.org
Suicide Awareness Voices of Education (SAVE)
SAVE’s Mission is to prevent suicide through public awareness and education, eliminate stigma and serve as a resource to those touched by suicide.
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Introduction
A very dear friend recently confided hat she is seriously considering "ending it all," that life has become so much of a painful struggle, she no longer wants to live. How can you tell if a suicide threat is credible or a ploy to get attention?
Social workers are highly skilled in crisis intervention and can help you to determine how real a suicide threat is. The social worker can also point you in the right direction. This might be as immediate as a trip to the emergency room, or an appointment with a mental health professional for one on one counseling or psychotherapy.
The social worker can also offer counseling for all those involved, whether it's the friends who have been taken into confidence by a person threatening to kill himself, or the families who have discovered that a loved one is suicidal.
Social workers also recognize the need to actively reach out to at-risk teens and to educate the school community about warning signs and suicide prevention. Suicide is the third leading cause of death for those between the ages of 15 and 24, right behind unintentional injury and homicide.
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Help from a Primary Care Physician and a Social Worker Make a Difference
Although it may not be commonly known, senior citizens have the highest suicide rate of any group of Americans. That's the bad news. The good news is that when the depressed elderly are by a doctor and receives depression care management from a social worker, their chances of improving are better than when they receive care from a doctor alone. These are the results of a resent study published in the Journal of the American Medical Association in 2004.
Martha Bruce of Cornell University, Charles Reynolds III of the University of Pittsburgh and colleagues conducted the study to tackle the issue of elderly suicides.
Called PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), the trial recruited patients from 20 primary care physician practices in New York City, Philadelphia, and Pittsburgh.
Nearly 600 patients suffering from depression ranging in age from 60 to 94 years were studied. Social workers, nurses, and psychologists were depression care managers for these patients.
The study revealed that patients who receive depression care management services in addition to a physician's care improved more quickly than those under the care of only a physician. After four months, 56 percent of patients who initially experienced suicidal thoughts no longer suffered from them, compared to 30 percent of usual-care patients.
Another benefit was that the patients in this study saw a reduction in the number of symptoms of depression they had been experiencing. They also responded better to treatment. These positive results led the study's authors to conclude that routine depression screening of elderly people in primary care can be very beneficial if it is followed with treatment and care management.
Treatment guidelines provided to doctors in the study recommended a trial of antidepressant medication. If a patient declined medication therapy, the physician could recommend interpersonal therapy from the care manager. Care managers had backup, weekly supervision by psychiatrist investigators and monthly supervision of interpersonal therapy.
Care managers helped the primary care physicians recognize depression and offered guideline-based treatment recommendations, monitored clinical status and provided follow up. Research associates introduced the depression care manager to patients immediately after the baseline review. Care managers interacted with patients at scheduled intervals or when clinically necessary either by telephone or in person.
The comparison treatment was the usual primary care with the addition of initial education of physicians about the treatment guidelines and notification when a patient met criteria for depression. These were added to usual care to protect patients and keep the study focused on depression treatment and management rather than recognition.
The study's results varied based on the level of depression severity and the presence of suicidal ideas. The authors said it is important to build on the success of these trials by developing effective strategies for implementing successful interventions in routine practice, increasing the efficacy and disseminating them more broadly.
Source: NASW News, May 2004
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Dottie Wormser of Hampden Township looks at photographs of her son, Mark Wormser, who took his life by hanging at age 15 in November 2000. (Jason Minick/The Sentinel) |
Most teens deal with adolescent angst and emerge as healthy young men and women.
But some don’t.
Suicide is the third leading killer of youth between the ages of 15-24.
Warning signs of depression and suicide often are attributed to normal teenage behavior — making it difficult for parents and teachers to respond to youth in crisis. In addition, some question whether schools should play any role in providing mental health services for troubled students.
The Sentinel takes a look at these sensitive issues in a four-part series that starts today with the story of Dottie Wormser’s struggle to lead a normal life in the wake of her son Mark’s Nov. 14, 2000 decision to take his own life.
Graduation — the right of passage to adulthood. In this case, Cumberland Valley High School, Class of 2004.
This should have been the happiest night of their young lives. Instead, it was filled with moments of crushing sadness.
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Mark Wormser’s CV classmates included him in their yearbook. |
The class was short two members— two outwardly happy, healthy young men who each seemed destined to accomplish great things and change lives.
But they chose death instead.
Mark Wormser, 15, of Hampden Township, was in therapy when he took his life in 9th grade. The product of an otherwise happy home, he began cutting himself during the summer of 2000 and quickly descended into a personal hell culminating with his death at home on Nov. 15.
Fast forward three-and-a-half years. Tragedy again touched the lives of classmates when popular senior Corey Bischof, 18, disappeared and was found dead of a self-inflicted gunshot wound in May 2004. Starting quarterback for the wildly successful CV Eagles football team, Bischof’s death stunned the entire community.
Family members and friends of both teenagers were left to grapple with the obvious question: why?
“You take it very personally that the love I had for Mark wasn’t enough to keep him going,” says Dottie Wormser, Mark’s mother. “I have to remind myself that Mark just couldn’t see past his problems.”
A piece of Dottie Wormser died with her son. Her road to peace and recovery has been bumpy. The Wormsers’ Hampden Township house burned to the ground two months after Mark died. Years of therapy followed the tragedy.
Today, Wormser lives in New Cumberland and leads the Suicide Survivors Group that meets monthly at Polyclinic Hospital in Harrisburg.
And she continues to heal a little bit each day.
“It doesn’t come after me like a sledgehammer anymore,” she says of the pain.
This is her story.
A tragic day
Wormser understands all too well the hell the Bischofs are living. She has lived it since returning home from work the day she discovered Mark had hung himself.
“I look at it as Mark took himself out of his own personal hell and put me in it,” she says quietly at her kitchen table.
Wormser says her youngest son “seemed to enjoy life.” He looked forward to the things typical 15-year-olds do — getting a driver’s license and his first job.
A Florida Marlins baseball fan, Mark rode skateboards in the summer and snowboards in the winter. He studied karate. He wrote poetry and had a girlfriend he loved. Proficient in computers, he talked of becoming Microsoft-certified or even attending West Point after high school.
Mark was the kid who sought out wandering students in the hallways and pointed them in the right direction, his mother says. He was known as “Little Worm,” while older brother Kevin was the original “Worm.”
“Mark had an eye out for how other people were doing,” Wormser says. “He was very charming. That’s not to say we didn’t have typical teenage ups and downs because we did.”
She recalls no specific incidents that led her to believe Mark would take his own life. He was a normal teenager, she says, and that includes typical “rebellious behavior.”
Mark toyed with coloring his hair, but he never did. He was surprised when his mother gave her permission for him to pierce his ears. He never did. Once early that summer, Mark ran away and was gone all night. That episode was quickly forgotten.
“He was spending a lot of time on the Internet, but he said he was chatting with his friends,” Wormser says. “That was a mistake I guess — having the computer in his room.”
She later discovered that Mark’s webpage included observations on suicide.
A change
Mark’s mood changed for the worse the summer before his death.Hewithdrew, spending more time in front of the computer.
Finally, his mother suspected he was cutting himself.
“I had seen the scratches on his arm and he’d say ‘The cat scratched me’ or ‘I was roughhousing with the dog,’” Wormser recalls.
Later, Mark admitted he had cut himself “to prove to himself that he was alive,” she says. A picture in a spare bedroom shows Mark skateboarding that summer while wearing a long-sleeved coat. Wormser now believes he was hiding self-inflicted wounds on his arms.
She recognized the cry for help and got Mark into therapy. Unfortunately, she was unaware of the depths of his depression — underscored in the poetry he wrote and the suicidal messages she later read on his website.
“There were some dark places in that poetry,” she says. “He was so good at hiding things from me I guess.”
As therapy progressed, Wormser became a vigilant protector of her son, making nightly phone calls from work and urging him to make morning promises regarding his own safety.
“I made him promise not to take his life that day,” she says, recalling a typical conversation. “I did whatever I thought I needed to do to keep him going.”
The two-week program at PinnacleHealth was “very focused,” Wormser says. “Unfortunately, Mark balked at most of it. He wasn’t doing a lot to open up or cooperate.”
The program took place in October. Mark wrapped it up a day early and did not go back. Still, the Wormsers had high hopes.
“I didn’t have a lot of anxiety about it because I knew that kids who cut themselves are not generally suicidal,” Wormser recalls. “I thought we had a pretty clear road ahead of us. I thought he’d get the help he needed and we’d be OK.
“After we discovered he was suicidal, I don’t remember much about that time. I know we had a great deal of difficulty getting him to go to therapy.”
Mark was prescribed Prozac. His mother later learned he stopped taking the drug sometime before his death.
Initially, “he showed no hesitation,” she recalls. “He took it very willingly. I thought he was taking it. I probably should have watched him take them every day.”
Wormser concedes the likelihood that “as a parent you’re looking for signs that your child is better or over (the crisis).”
‘Tried several times to get through’
Wormser frequently called home from work to check on her sons. The night Mark died, she believes he was on the computer for several hours.
“I don’t have a clear picture of what happened that night,” Wormser says. “I tried several times to get through that evening and I never did.”
Returning home after her 3-11 p.m. shift, Wormser found Mark’s lifeless body.
She futilely tried to revive him with CPR. A suicide note in his pocket revealed 13 wishes. Among the most disturbing is Mark’s wish “not to be remembered.”
“Everybody wonders why,” Wormser says. “Why would this wonderful boy not want to be remembered?”
Wormser feared for Kevin and became fiercely protective or her remaining son. Research indicates family members of a suicide victim are susceptible to repeating the tragedy. Wormser admits the thought crossed her mind once or twice.
“I remember thinking wouldn’t it be nice to join Mark,” she says. “I wanted to be there to guide him through the afterlife.”
Wormser has few memories of the days and weeks following her son’s death.
“I remember going to plan his funeral with the funeral director,” she says. “It was something that I had to do for my son. For the first week or so you’re kind of on autopilot.”
Mark’s best friend insisted on speaking and did so quietly. Another friend played “Amazing Grace” on the bagpipes.
Every so often, Wormser hears from someone who was at Mark’s funeral. Most of the time she does not remember having seeing that person.
She calls her work as a nurse at Harrisburg Hospital “my saving grace” and credit co-workers for keeping her alive.
“After Mark died, I remember thinking the best thing that would happen to me was I would go to work. It kept me sane for awhile. But for the first few months, it wouldn’t take more than five minutes for Mark to creep into my mind. Anything and everything would remind me of him…
“For months and months the first year,” she adds that “every time I drove home from work I would almost always cry because it would be all that pent-up anxiety from being at work.”
Therapy helped Wormser work through the grieving process.
“For those first few months my thoughts of Mark were almost never happy memories,” she says. “Now it’s very comforting to know I can think about Mark… and I rarely cry. I wonder if that isn’t because I cried all the tears out of me. Now mostly I tend to feel like I want to cry when I find out about somebody else who has lost somebody to suicide.
“I remember the first day I didn’t shed a tear for Mark,” she says, “and I felt so guilty. It got to be about 10 (p.m.) or so and I remembered I hadn’t shed a tear for Mark… I was berating myself for not crying for my son.”
A graduation remembrance
Principal Dominic Cavallaro urged CV families to remember both Mark Wormser and Corey Bischof during the class’ June 8 graduation ceremonies at The Giant Center in Hershey.
In the front row, Wormser and a friend sat with the Bischofs. Random thoughts raced through her mind as Cavallaro spoke: “Don’t cry… Don’t make a fool out of yourself… Be strong for the Bischofs…”
Candles were lit in honor of Wormser and Bischof and their parents were called forward to receive diplomas meant for their deceased sons.
“I was told by people in the audience that it was very moving and very touching,” Wormser says.
Although she still cries easily when talking about her late son, the graduation represented a healing of sorts.
“A certain calm came over me since his graduation,” she says. “I don’t feel that inner churning that I feel a lot when I think about Mark.”
Helping to ease the pain
Dottie Wormser might not have survived were it not for her suicide support group.
Now she is taking over as facilitator of the group — which meets the first Wednesday of every month at Polyclinic Hospital, 1 Landis, Simpson Board Room, 2501 N.Third St., Harrisburg.
A licensed social worker, Ned Hoffner, ran the support group for the last seven years. About 8-10 people attend — some for many years.
“We have parents, we have grandparents, we have siblings, we have spouses,” he says. “While the pain is still there for them, they’ve moved on to some degree. That pain will always be there for them but they’ve found a better way to control it.”
Most of the members in the group have lost someone younger than 21, Hoffner notes. “At this time, the makeup of the group is everybody’s grieving a male,” he adds.
Sponsored by WomanCare Resource Center, the group meets from 7-9 p.m.
Young males often choose hanging
Hanging and other forms of suffocation have overtaken guns as the chief means of suicide among American youngsters aged 10-14, according to statistics released last summer.
Researchers from the Centers for Disease Control and Prevention say they first noticed the trend in the early 1990s. By the end of that decade, suffocations had surpassed self-inflected shootings.
Health officials said they do not know why the switch occurred and whether it had anything to do with the use of trigger locks, lock boxes and other measures taken to keep guns out of youngsters’ hands.
By contrast, suffocations are often carried out with common household items such as belts, ropes or plastic bags.
The CDC reports 96 suicides by suffocation among Americans aged 10-14 in 1992.
The number rose to 163 in 2001, with firearm suicides dropping from 172 to 90 during the same period.
Suffocation suicides also rose among teens aged 15-19 during the same period (from 333 deaths a year to 551).
Firearms remain the most common means of suicide for that group, although the number of deaths from self-inflicted shootings dropped from 1,251 a year to 838, the CDC says.
Overall, the suicide rate for ages 10 to 19 fell by about a quarter, from 6.2 deaths per 100,000 people in 1992 to 4.6 per 100,000 in 2001, the CDC adds.
2005 The Sentinel, Carlisle, Pa. unless otherwise noted.
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Introduction
A friend one day confides that she’s considering “ending it all.” That her life has become so terribly unbearable, there is no reason to go on.
After the initial shock, your first reaction may be to shrug off the suicide threat and assure the friend that her life really isn’t so bad after all.
Don’t.
Trying to convince someone that they have everything to live for may only increase their feelings of guilt and hopelessness. If someone tells you they are thinking about suicide, even casually or in jest, pay attention! No suicide threat should be dismissed or taken lightly.
Seeking a Sign
Rarely does someone commit suicide out of the blue.
They drop hints, speak outright of their desire and exhibit certain predictable behaviors. These may be:
- a preoccupation with death;
- a loss of interest in things they ordinarily cared about;
- visiting or phoning loved ones;
- making arrangements or setting one’s life in order;
- giving away prized possessions;
- comments about hopelessness, helplessness or worthlessness; and
- daring or risk-taking behavior.
What Can You Do?
Be direct. As uncomfortable as it might be, talk openly and matter of factly to the person about suicide and be prepared to listen in a non-judgmental way. Pose direct questions, for example, does the person have a plan?
If possible, try not to act shocked, as this will only place distance between you and the person.
Above all, do not swear to secrecy.
This is a time when you need support. Trust your instincts that something is terribly wrong and that the person may be in deep trouble. Reassure them that help is available, depression is treatable and suicidal feelings are temporary. Urge them to contact a social worker or other mental health professional, a community mental health agency, a family doctor, a school psychologist or counselor.
The decision to commit suicide is quite often a desire to stop suffering. Never give up on someone just because he or she tells you he’s made up his or her mind.
Help! What If The Threat Is Immediate?
Phoning 911, or taking the person to a hospital emergency room is a valid option. So is calling a crisis intervention center or a suicide hotline (see below for key numbers and organizations).
If possible, remove or hide any potentially dangerous items, such as pills, firearms and other weapons, even belts and ropes.
- 1- 800-784-2433, or SAVE (Suicide Awareness Voices of Education)
- or 1-800-273-TALK (8255) (National Suicide Prevention Lifeline)
- Or 1-800-SUICIDE (784-2433) (The National Mental Health Association)
Suicide Statistics
- More people die from suicide than from homicide in the U.S. every year.
- Roughly 30,000 Americans commit suicide annually, while 500,000 attempt.
- For young people ages 15 to 24, suicide is the third leading cause of death.
- Men are far more likely to die from suicide than women. However, women are more likely to attempt suicide than men are.
- Suicide rates are generally higher than the national average in the western states and lower in the eastern and midwestern states.
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