I received an email recently from suicide bereavement support group facilitator Marcia Epstein about two remarkable young men who are biking across the country to bring attention to suicide's impact on individuals and communities. Marcia directs the Headquarters Counseling Center in Lawrence, Kansas, where local survivors had a potluck dinner for the cyclists. Zachary Chipps and Thomas Brown met in 2009 as co-workers in an after-school youth recreation program in Scottsdale, Ariz., and discovered that each of them -- when they were 24 years old -- had lost their older brothers to suicide. Their common experience sparked their creativity (Zak is a drummer, Thomas is a video artist), and they formed R.I.S.E. (Revolution Inspired by Self Evolution) to organize the cross-country trek, which began in March at the Golden Gate Bridge in San Francisco. They will be using various forms of media, including blogging and in-depth video shorts, to connect more intimately with those who are participating and following their journey. While many have traveled by bike or foot across the country, and have blogged about their adventures, their planned extent of real-time video blogging will be unprecedented. Thomas will film the entire tour, providing a collective view of suicide, the ripple effect it can create in one’s life, family and community, and how “personal reflection and creative expression can be a catharsis to counter stressful ordeals." Below are examples of the video clips Thomas and Zak are posting along the way, the first one features Thomas a few days after their journey began on the West Coast, and the second one features Zak more than two months later in eastern Kansas:
A scientific study reported earlier this year in an American Heart Association journal confirms that the physical effect of grief truly can be a serious matter. In fact, according to a WebMD article: Following the death of someone close, the researchers found that heart attack risk - • was 21 times higher than normal within the first day;
- • was nearly six times higher than normal within the first week; [and]
- • steadily declined over the first month.
This risk needs to be studied further, researchers say, noting that heart attacks caused by grief are relatively rare in the overall population. [They] theorize that the emotional stress of grief, including anger, anxiety, and depression, can take a toll on the heart ... And after losing someone they care about, people tend to sleep and eat less, and they may smoke more and forget to take their medication.
These are some of the reasons why people who are grieving are at a much higher risk for heart attack than usual.
"Friends and family of bereaved people should provide close support to help prevent such incidents, especially near the beginning of the grieving process," says researcher Elizabeth Mostofsky, ScD ... [of] the Harvard School of Public Health in Boston.
The American Psychiatric Association has opened a final period of public comment on the draft criteria for the new version of the Diagnostic and Statistical Manual (DSM-5). The DSM -- the catalog of mental illnesses in the United States -- serves as the ultimate authority regarding which constellations of symptoms are designated as bona fide illnesses and, therefore, are proper objects of professional treatment. Public comment can be submitted through June 15 on the DSM-5 Development website. I recommend an article in MedPage Today, "DSM-5: What's In, What's Out" as an excellent summary of all the criteria still subject to further comment and revision before the new manual is released in May 2013. Several of the proposed revisions are of special interest to grief support practitioners: In the case of eliminating the bereavement exclusion for diagnosing a Major Depressive Episode, which MedPage Today notes has been "one of the most controversial proposals in DSM-5,"* the APA workgroup is now proposing that the exclusion be retained but that a prominent notice be added to the diagnostic criteria, differentiating symptoms of normal grief from those that might need clinical intervention: Note: The normal and expected response to an event involving significant loss (e.g, bereavement, financial ruin, natural disaster), including feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss, may resemble a depressive episode. The presence of symptoms such as feelings of worthlessness, suicidal ideas (as distinct from wanting to join a deceased loved one), psychomotor retardation, and severe impairment of overall function suggest the presence of a Major Depressive Episode in addition to the normal response to a significant loss. In addition, it is proposed that Persistent Complex Bereavement-Related Disorder -- which refers to an experience of grief that is prolonged or severe but cannot be diagnosed as including a Major Depressive Episode -- be placed in Section III of the DSM-5, which highlights conditions that merit further research before being included as diagnosable mental illnesses. * Two previous Unified Community Solutions blog posts have covered the bereavement exclusion:
Over the years, as I have worked with (and learned a great deal from) people who have lost a loved one to suicide, I have tried to understand what the goal of grief is. Is it to move on? To heal? To go on a journey? To integrate the loss? To make meaning of the death? All of these goals -- and many, many more -- have been named for me as different people's ideas of what the objectives of grief might be. And the conclusion I have come to is that every bereaved person's goal is different. However, as a grief support practitioner -- someone who tries to help bereaved people -- I have found it important to have goals for myself as I do my work, and it has been useful to me to view grief through the lens of recovery. If I am guided by the principles of recovery, I can focus on the process, and the bereaved person I am working with can determine his or her own goals. The recovery model that I believe is the most broadly applicable to my work is from the National Consensus Statement on Mental Health Recovery, the elements of which I have outlined below (I've shortened them from the original, and altered some of the wording to focus on bereavement). These recovery principles guide my work: - Self-Direction: Grieving people ought to lead, control, make decisions about, and define their own recovery through autonomy, independence, and access to resources. Recovery must be self-directed by individuals determining their own life goals and designing a path to reach those goals.
- Individualized and Person-Centered: The pathways to recovery are as multiple and various as the nature of individual bereaved people are. Recovery is at the same time an ongoing journey and an accomplishment, and it is a means for achieving optimal mental health and overall wellness.
- Empowerment: Individually and collectively, bereaved people must be empowered to control their destiny in organizations and communities. They must be able to choose among a range of options, participate constructively in decisions that affect them, and efficiently remedy their grievances.
What are your ideas about the "key ingredients" of peer suicide grief support? Please join the discussion on this important topic.Peer grief support is an emerging field of practice that is especially applicable to helping people bereaved by suicide. For ages, those who have experienced grief themselves have offered to assist newly bereaved people, and now peer helper programs and training are among the forces transforming this means of support into a systematic practice. A significant amount of suicide grief support is delivered by peers, especially through suicide bereavement support groups, and it would be valuable to take a look at lessons being learned in other areas where peer helpers are delivering services. One such area is the U.S. military, regarding which a white paper was recently published, "Best Practice Identified for Peer Support Programs" ( download available). The document identifies the following "key ingredients ... [that] account for the special effectiveness of peer support interventions": - Social support includes "emotional support, information and advice, practical assistance, and help in understanding or interpreting events."
- Experiential knowledge (particularly knowledge based on common experience) gives peer supporters "greater credibility as 'experts' in dealing with the problems and challenges faced by the person seeking support."
- Trust is present when the person being helped experiences the helper as honest, unselfish, and reliable.
- Confidentiality is the centerpost of effective peer assistance, in part because it is the basis for trusting the helper.
- Easy access is fundamental for obvious reasons: Even if a peer support program is extraordinary in every other way, it cannot be effective unless people who need help are able to take part in the program.
 In this HLN-TV interview, Donna Barnes, executive director of NOPCAS (National Organization of People of Color against Suicide), and William and Naomi Powell, who facilitate a support group for survivors of suicide loss, talk about suicide and grief in the black community. The interview was broadcast in the wake of the suicide of Don Cornelius, who is characterized in a New York Times story as the person "who brought black music and culture into America’s living rooms when he created the dance show 'Soul Train.'” HLN-TV reporter Richelle Carey says her hope is that this interview will help "break the silence and the shame that comes with such a tragedy," and points out that suicide is the third-leading cause of death among black men age 15-24. Barnes, whose son Marc died by suicide in 1990 (learn about the history of NOPCAS), addresses the culture of silence surrounding suicide
Ed Shneidman, the father of modern suicidology, declared the following in his foreword to Albert Cain's 1972 book Survivors of Suicide:
A benign community ought routinely to provide postventive mental health care for the survivor-victims of suicidal deaths. Postvention is prevention for the next decade and for the next generation. Of the three possible temporal approaches to mental health crises -- prevention, intervention, and postvention -- in the case of suicide at least, postvention probably represents the largest problem and thus presents the greatest area for potential aid. [Cain, A. C. (Ed.). (1972). Survivors of suicide. Springfield, IL: Charles C. Thomas.] Shneidman's declaration refers to postvention specifically focused on meeting the needs of the bereaved after a suicide fatality. He asserts that "postvention ... presents the greatest area for potential aid," and I believe the suicide prevention field has overlooked a practical approach centered around suicide grief support services that would exemplify "prevention for the next decade and for the next generation." Specifically, by a "practical approach," I do not mean a particular program or product: I mean the public health approach to prevention.
ADEC, the Association for Death Education and Counseling, has made two valuable resources publicly available on the Internet, which cover important background information on the proposed removal of the bereavement exclusion for depression in the DSM-V (see " DSM Debate Grows over Grief and Depression"). The newly revised and updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V) -- which is the result of several years of intensive and comprehensive review, analysis, and discussion by the foremost experts in the world -- is expected to be completed by the end of the year. The ADEC resources are free to access: - The summary of a report, "Removing the Exclusionary Criterion about Depression in Cases of Bereavement," submitted to the ADEC Board of Directors in November 2010 by its Scientific Advisory Committee
- The full content of the webinar "The DSM-V Exclusion Criteria Explained, Processed, and Problem Solved," which will be available online for the next month (through March 21).
A recent New York Times article highlights a growing controversy over the next version of the Diagnostic and Statistical Manual (commonly called "the DSM"), which is the bible of classifications of mental disorders in the United States. Even as it is due at the printers in December, new material planned for DSM-V is being intensely debated, including the proposed elimination of the current exclusion from a diagnosis of depression for a person experiencing grief: Under the current criteria, a depression diagnosis requires that a person have five of nine symptoms -- which include sleeping problems, a feeling of worthlessness and a loss of concentration -- for two weeks or more. The criteria make an explicit exception for normal grieving, which can look like depression (Benedict Carey - "Grief Could Join List of Disorders" - New York Times - 01/24/2012). On one side of the argument are those who believe the current exclusion does a disservice to grieving people who would benefit from a diagnosis of (and treatment for) depression: “If someone is suffering from severe depression symptoms one or two months after a loss or a death, and I can’t make a diagnosis of depression, [says Dr. David Kupfer, professor of psychiatry at the University of Pittsburgh School of Medicine,] well, that is not being clinically proactive. That person may then not get the treatment they need” (Carey). On the other side are those who fear that grief will come to be considered as an illness: “An estimated 8 to 10 million people lose a loved one every year, and something like a third to a half of them suffer depressive symptoms for up to month afterward,” [says Dr. Jerome Wakefield of New York University]. This [eliminating the exclusion] would pathologize them for behavior previously thought to be normal” (Carey).
Here is a quote from "What to Do about Valentine's Day," by Cheryl Eckl, whose husband died of cancer in 2008: The problem is that it's Valentine's Day weekend—which always brings up the whole idea of love. And, for widowed persons, the question of loving again after loss. Clearly, this is a matter I have avoided because, in surveying my present circumstance, I realize that I have, indeed, replaced my husband—but ... not with a sentient being. These days I spend the majority of my time with my desktop Mac, laptop, iPhone, and soon-to-be-purchased iPad.
Judging from the e-mails I have received from other widows, I suspect I'm not alone in this situation. But this lover's holiday does kind of rub my nose in the fact that there is nobody in my life right now who is going to send me flowers or take me out to a nice romantic dinner. My electronics may be interactive devices but they are neither thoughtful nor proactive when it comes to the most basic of human needs: relationship. The original article was posted on Feb. 11, 2012 to Cheryl's blog, "A Beautiful Grief," which is hosted by Psychology Today.
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