Let’s talk about suicide…

I’ve been reading a lot of posts about suicide since the sad announcement of Chris Cornell’s death yesterday.  Most of the information provided is assumptive, and not based on research or statistics.  Here are some of the facts from the World Health Organization’s 2015 dataset:

  1. Suicide is not the most common cause of death; it is the 17th leading cause of death worldwide.
  2. Suicide does not just affect young people; it occurs throughout the lifespan.
  3. It is not just men that suicide, women do too.
  4. Close to 800,000 die via suicide each year, with many more attempted.
  5. Suicide can be prevented.

Why is suicide different to any other death?

Suicide is different because the person who we love chose to end their own life prematurely. That sentence on its own is a powerful concept to process, as it throws up all kinds of questions and emotions. It also alters the way other people interact with us as grievers.

There are many reasons why bereavement can be different after suicide and they can include:

  • The questioning of religious beliefs
  • Guilt
  • Anger
  • Stigma
  • Denial
  • Absence of support
  • Silence
  • Other people’s perception or interpretation of the situation both pre death and of the death
  • Curiosity
  • Police involvement
  • Coroner involvement
  • Rejection
  • Heightened fear of genetics
  • But mainly “why?”

 

What are some of the reasons for suicide?

Aside from obvious mental health issues, such as drug addiction or bipolar disorder, that may lead a person to suicidal thoughts and actions, there are four psychological needs that need to be met, according to an expert in suicide, Dr. Nicola Tweedie[1] :

Thwarted Love;

We all want to feel loved, accepted, and that we belong.  If we feel isolated or lonely. or excluded from our network groups, this can lead to low self worth. Alternatively, wanting to belong to a displaced group e.g. where there is a spate of teenage suicides in an area, can be seductive.  The perception of joining them and becoming part of the group is a powerful attraction.   Suicide can therefore appear to be a solution i.e. “no-one ever loved me anyway, no-one will care” either as a result of exclusion or the desire to be included.

Fractured Control:

Most humans enjoy predictability, stability, autonomy and some order in their lives.  When there is a perception of no or littel control, for example when we lose a job, are declared bankrupt, or divorce etc., suicide can seem like the only option to escape from the situation.

Assaulted Self Image:

In situations where someone has been bullied or subject to any manner of abuse, the resulting emotions can be shame, humiliation, or other associated feelings.  This can lead to the perception that the only way to cope with these feelings, particularly when functionally crippling, is to avoid them.  However if the emotions are too overwhelming, and possibly having a significant traumatic effect, suicide may be perceived as an escape route.

Excessive Anger:

Rage and hostility are associated with frustrated needs, and can lead to the ultimate act of rage against the human form.

Why is suicide different for grievers?

Van Derwal (1989)[2] identified the areas that are qualitatively different for those bereaved from suicide:

  • A prolonged search for the motive.
  • Denying the cause of death due to stigma and societal responses.
  • Feelings of rejection (both by the deceased and sometimes society).
  • Religious questioning.
  • They are more often likely to conceal the cause from others.
  • A heightened fear of a genetic /increased risk of suicide for themselves and their family.

 

How do we support those bereaved through suicide?

There is a simple answer to that question; in the same way you support anyone through a life event that is overwhelming and devastating:  with empathy, compassion, open mindedness & authenticity.  Just being there and/or listening is enough.

(Please note: The use of the word ‘committed’ with reference to ‘committed suicide’ is not particularly sensitive to the bereaved due to connotations of ‘committing’ a crime, particularly if the griever has a religious affiliation.)

For further resources see:

http://www.annemoss.com – a blog by a bereaved mother after her son suicided

http://www.Samaritans.org  – a helpline and support for anyone feeling suicidal

http://www.uk-sobs.org.uk – for support if bereaved through suicide

 

[1] http://finder.bupa.co.uk/Consultant/view/183553/dr_nicola_tweedie

[2] Van der Wal, J. (1989-90). The aftermath of suicide: A review of empirical evidence. Omega, 20, 149-171.

 

 

 

Grief Demystified..

Please see my previous post about why I had to delete several of my informational blogs. In the meantime I’ve been busy putting all of the information from them, plus a whole lot more, into a book comissioned by Jessica Kingsley Publishers.
The book will be called Grief Demystified and explains everything you’ve ever wanted to know: do men and women grieve differently? why do we grieve for famous people? how do I know if I’ve grieved properly? and what to say to the  bereaved, plus many more questions answered.  It also includes a list of recommended bereavement organisations that provide online resources, offline support and signposting.  It also includes an extensive list of references if, like me, you are interested in furthering your knowledge in grief and bereavement from the experts.

And best of all- there are diagrams and photos for visual learners and the easily bored 🙂

I shall write more blogs soon about the myths that still pervade on social media, because I keep seeing misleading articles and outdated information…

Content..

It is with regret that I have had to delete many posts due to persistent plaigiarism. I started this blog to share information as a result of 28 years of reading, training, volunteering, experiencing bereavement & client support work.  But reading my words over and over again without reference to this blog  was hugely disappointing.

Thank you to those of you that sent messages saying they helped you or that you’ve used them to educate others.  Thank you also to those that liked or commented on them.

If you would like to access the original blog material or have any questions on grief theory, please contact me directly and I’ll be happy to share them.

#Life.WhatTheF#ckIsThis.Death

I was delighted to be invited to join the ‘cast’ of #lifedeathwhatever this week at Sutton House in Hackney to talk about my passion: grief following a bereavement.  I was excited for predominantly two reasons; 1. because ordinarily no-one wants to hear me bang on about theories and debunking the myths that still abound about grief, and 2. I wanted to explore the beautifully curated creative exploration of life and death that beckoned.

Sutton House is a National Trust property that is beautifully preserved, and the curators @anna_eol_doula and @poetic_endings have done an outstanding job of adding beautiful installations to it.  One example was a coffin playroom which consisted of coffins full of multi coloured balls for tactile exploration.  There was also an ‘all that’s left unsaid’ exhibition of cards with sentiments written on them such as ‘you said you loved me, you lied’ and ‘you should have knocked and asked to come in’.  This was also an opportunity to examine a pink hearse, drink death themed cocktails and eat a herb supper.

But enough of the interesting exhibition -never one to miss an opportunity, I’d like to share a brief overview of the content of my workshop with you.

The first part of the presentation was exploring the differences between intuitive and instrumental grievers (Martin & Doka, 2010) with specific personality types.  Whilst these are generalities, exploring the combination of variables gives rise to explaining why different people exhibit grief in different ways.  I’ve written about this at length in my book Grief Demystified, due to be published by JKP in 2017.

Secondly we had a discussion around the myths of grief.  ‘Are you over it yet’, ‘time heals all wounds’, ‘you can always have more [children] and the big one: the 5 stages of grief.  For those who are unfamiliar or haven’t checked Wikipedia.com lately,  the five stages of grief were identified by Elisabeth Kubler-Ross as the grief emotions experienced by those who were dying in the 1960’s, not the bereaved.  The model was later expanded by Elisabeth to encompass grief but she was very clear that the stages are not linear and not intended to be interpreted that way.  There are several more modern models of grief that are preferable to demonstrate the reality of bereavement.

Lastly we explored the impact of social media and how our digital legacy affects grieving. The consensus was that the immediate family should have control, and power of veto over who should post, and what content should be allowed to be published publicly.

For further information on this workshop or if you would like to chat to me about running one or attending one of my training courses, please contact me at thegriefgeek@yahoo.com.  I am always delighted to share this with anyone interacting with the bereaved, to the bereaved, or anyone supporting the bereaved professionally.

In conclusion, I would highly recommend a visit to http://www.lifedeathwhatever.com when the next one is running.  The exhibitions and events are life affirming and invigorating and are perfectly situated within an atmospheric and beautifully historic venue.

 

 

 

Death and Culture in York- My Thoughts..

I just wanted to return here to document some interesting ideas and information I gleaned from the recent Death and Culture Conference at York University. The conference was an interdisciplinary event involving a wide array of perspectives across the full range of death, dying and bereavement topics, but not excluding other related areas.  Here is a summary of my highlights from a varied and fascinating three day programme:

Dr Karina Croucher presented a very interesting talk about her partnership with Christina Faull of LOROS Hospice in Leicester on their joint research, combining archaeology and continuing bonds.  An unusual combination on the surface until she explains ‘I study the mortuary practices (i.e. the ways in which people reacted to death and treated their dead) in the past’ and then you realise this joint research is completely logical and will be fascinating when completed.

Brenda Mathijssen spoke on the theme of continuing bonds.   She talked about the wearing and retention of ashes and how these items, created from the remains of our loved ones, are so significant when we are initially bereaved, but over time they lose their significance.  The continuation of bonds that are so necessary for us to grieve, ultimately become transformed bonds- which reminded me of J. William Worden’s final stage of relocating the deceased.  Interestingly she stated that there is a 30 day waiting period in The Netherlands after cremation before you can collect the ashes.  Those 30 days are designed for thinking and processing.

Dr Heather Conway raised the issue that there are currently 3.5 billion internet users worldwide, so  consideration should be given to the legal aspects concerning our digital legacy.  There are many issues to consider: what is a digital asset and what expires at death, the etiquette of virtual cemeteries, digital wills, Facebook memorials, other social media sites and legacy or deletion decisions.  She asked; are digital companies sustaining the view of an afterlife, how are the hierarchies of grief affected, what about contested narratives, what should the virtual memorial rules be etc.

Chao Fang delivered a fascinating presentation on the advent of ‘Shidu’ or the loss of an only child in China.  Due to the government policy of one child per family, the death of a child has political ramifications that perhaps don’t exist in other cultures.  Additionally, older people in China are reliant on their children as there is little social support, so the loss of their child has significant secondary loss implications, including financial implications.  There is also a ‘shame’ in not having children in China, that makes them feel that they are ‘unable to face their ancestors’ after the death of an only child, and that this is ‘the most distressing thing ever’.

There were also talks that discussed the issue of the ‘social dead’ i.e. slaves in Capetown and Barbados. I wondered about the bereaved and their ability to process meaning making after such heinous events, but the focus was on the deaths and lack of memorialisation not the living…

There were also presentations about the sensationalism of murderers and the lack of narrative surrounding the victims. I wondered if I would welcome public reminders of my loved one if they had been murdered?

Lastly a special mention & thanks to Dr Ruth Penfold-Mounce and colleagues for organising this event, it must have been a lot of work but well worth it – a fabulous time was had by all!

Do as I say and not as I do…?

Today I’m hugely conflicted.

I awake to a smart phone that flashes and beeps 24 hours a day, 7 days a week with social media notifications, and bereavement alerts of one description or another.

But today is not just another day; it’s the anniversary of my nephew’s death.  So I have notifications and reminders of this fact via Facebook, emails & texts- as if I wasn’t already acutely aware of the date.

The conflict is whether I share my memories or photos, or my feelings in such a public forum.  Do I change my profile picture? Post a photo of my nephew? Post a loving memorial telling ‘the world’ how much he’s loved and never forgotten?  Or do I keep quiet, and privately remember, and treasure our short time with him, and all the joy he brought in the three and a half years he was with us?

As a bereavement support worker, I’m an advocate for being open about death, dying and bereavement; a death denying society is not a healthy one in my opinion.  Death is a natural part of life, and grieving is necessary and healthy.  But I’m not sure I want to express my thoughts and feelings in such a public way, or to people that never knew my nephew.

Which brings me here.  To a fairly private, largely anonymous forum where I can express myself to those who ‘get it’, without the platitudes, and devoid of the ‘stalkers’ who are my friends that read but don’t comment..

This is my way & you will have your way.

So this is my tribute to a beautiful child that touched our lives in so many ways.

Always loved & never forgotten 💛

 

Does it matter how we talk about illness, death & grief?

“When I die tell the world what happened.

Plain and simple.

No euphemisms, no flowery language, no metaphors.”

Immortal words written by Lisa Bonchek Adams (Lisabadamscom, 2014) before she died from breast cancer.

The terminology around grief, death, and dying led to a recent conversation about the language we use to refer to cancer patients.  This in turn has led to copious amounts of reading on this subject to try to determine if language is helpful or detrimental during illnesses, death, and grieving.  All of the newspaper articles, news items, and social media posts we have seen have one thing in common: we use our language as metaphors to refer to these events, more specifically in “war” metaphors and/or “journey” metaphors.  Although we are noticing a lot more donning of battle armour than compass reading.

You would have to be avoiding all social media or conventional media not to be aware that the words “battle,” “fight,” “lost,” “won” etc. have become synonymous with the experience of cancer.  Do they originate from the patients, carers, Health Care Professionals, or Journalists?  And does it matter who uses the labels; are they useful or detrimental.  These are the questions we found ourselves asking and looking for answers to.

The earliest written reference to this we could find was with regards to Susan Sontag who raised this issue in her book Illness as Metaphor in 1978 (Sontag, 1978).  In the book she challenged the prevailing attitude of patient control that is whether the patient had control over whether they became sick or could “battle” an illness.  Her view was that illness is a biological condition and using metaphors to refer to the disease had a shameful or discouraging effect on patients.  As a cancer patient herself at that time, the notion that patients had some control over whether they developed certain diseases or had control over whether the treatment would work or not was offensive to her.  Following on from this in 1999 the late journalist John Diamond was referred to in the BMJ (McCartney, 2014) and quoted as saying “My antipathy to the language of battles and fights has….everything to do with a hatred of the sort of morality which says that only those who fight hard against their cancer survive it or deserve to survive it – the corollary being that those who lose the fight deserve to do so.”  So if the evidence points to respected journalists historically opposing such “battle” language how did it become endemic within society?  Did it slowly creep in via other journalists or can we answer this question by looking at whether patients, their friends and family (carers) and healthcare professions (HCP) find the use of metaphors surrounding cancer useful in any way.

On a mission to answer these questions is Professor Elena Semino and colleagues at Lancaster University who have spent the last few years studying the frequency of use of metaphors with regards to cancer and how they affect different people of the three groups identified above: patients, carers and HCP.  Her video lecture explaining the study and the results can be found here: https://t.co/KScIADr0ts .  They used sophisticated software to analyse 1.5 million words gathered from open social media sites and interviews and confirmed that the two most common metaphors used were what she termed “violence” and “journey.”  We are all familiar with “violence” words – battling, winning, losing, fighting, war on cancer etc.  “Journey” words and phrases are also familiar – “it’s the start of a long journey,” “I’m on the road to recovery” etc.  Semino at el.’s (2015) findings were that language seems to polarise in this area; it is either hated or loved.

On the positive side, it is used by fundraisers such as Cancer Research UK who use journey metaphors such as “Race for Life” to inspire and encourage and Macmillan who use “Survivorship” to motivate patients who have “beaten” their cancer.  Semino et al. (2016) also found that patients use journey metaphors “in a very empowering way” and violence metaphors are used by patients to find “purpose” and “meaning” by defining themselves as “fighters.”

Conversely Semino et al. (2015) found they can also have a detrimental effect.  Some people find they “don’t want to be on a road they don’t know how to navigate” and how do people with cancer battle with themselves?  Cancer patient Kate Granger (Granger, 2014) wrote in The Guardian newspaper; “‘She lost her brave fight.’ If anyone mutters those words after my death, wherever I am, I will curse them. … I do not want to feel a failure about something beyond my control.” Granger is a medical doctor and was diagnosed with terminal cancer prior to writing this article which makes you wonder how someone who knows they will die from an incurable disease can “fight” it?  I recall one of my friends vowing to “fight all the way” when he was diagnosed with bowel cancer a few years ago but then again he was an ex-member of the British army so the terminology was part of his identity.  The “fighting” talk slowly waned as his cancer metastasised and it was clear that he was terminally ill and in retrospect I wonder if he ever felt a “failure” for not “beating” it or if he ended his days satisfied that he had accepted any appropriate treatment that could have helped him and was accepting of his situation.

My point here is: however you choose to label yourself or what language you choose to use with regards to your body and your life is just that: your choice.  If you find battle or journey statements and metaphors helpful to deal with the psychological effects of being diagnosed and treated for cancer surely we should respect that.  However, I think if we impose it on someone that’s where the problems arise: we are imposing our expectations on them.  That they will “battle,” that they will “win” as if somehow it is within their control.  Contributing to making someone feel guilty or a failure is disempowering and surely unethical.

My conclusion is that there is the illusion of control with cancer if we use metaphors and perhaps that’s what someone needs in order to psychologically cope with the diagnosis of what used to be referred to as “The Big C.”  Does the thought of our impending death suddenly become a battle that needs to be fought?  We are one step closer to death every day whether healthy or not and we need to accept that as individuals and society.

If our loved one “battles” and “loses” their “fight” with cancer we are left to grieve their death.  With metaphoric expression there is the possibility that families and friends will be left wondering if their loved one did not “fight” hard enough or if they could have done more to help them.  This can potentially lead to further distress, anger, and guilt.

My view is that a good death leads to good grief and that can only happen if we discuss end of life issues open and honestly in whatever language is appropriate for each individual.  As end-of-life doula Anna Lyons (Lyons, 2016) says “Death is not the loss of a battle. Death is a natural part of life.

References

Granger, K. (2014, April 25). Having cancer is not a fight or a battle. Retrieved 8 May, 2016, from http://www.theguardian.com/society/2014/apr/25/having-cancer-not-fight-or-battle

 

McCartney, M. (2014). The fight is on: Military metaphors for cancer may harm patients. Retrieved 11 May, 2016, from http://www.bmj.com/content/349/bmj.g5155

 

Lisabadamscom. (2014, 10 October). Re-post of “When I die” – Lisa Bonchek Adams. [Weblog]. Retrieved 8 May 2016, from http://lisabadams.com/2014/10/10/re-post-die/

 

Lyons, A. (2016, March 21). “Hospitals are not a good place to die”. Retrieved 8 May, 2016, from http://www.netdoctor.co.uk/healthy-living/news/a26269/hospitals-are-not-a-place-to-die/

 

Semino, E., Demjen, Z., Demmen, J., Koller, V., Payne, S., Hardie, A., & Rayson, P. (2015). The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study. BMJ Supportive and Palliative Care. doi: 10.1136/bmjspcare-2014-000785

 

Sontag, S. (1978). Illness as metaphor. United States: Farrar, Straus & Giroux.