Last month, Susan Silk and Barry Goldman wrote for the Los Angeles Times a supremely insightful piece about interacting with people in distress, titled "How Not to Say the Wrong Thing." If a person applies their advice to talking to the bereaved, it's about as good as it gets:

Draw a circle. This is the center ring. In it, put the name of the person at the center of the current trauma ... Now draw a larger circle around the first one. In that ring put the name of the person next closest to the trauma ... Repeat the process as many times as you need to. In each larger ring put the next closest people. Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones ... Here are the rules. The person in the center ring can say anything she wants to anyone, anywhere. She can kvetch and complain and whine and moan and curse the heavens and say, "Life is unfair" and "Why me?" That's the one payoff for being in the center ring ... Everyone else can say those things too, but only to people in larger rings.

Silk and Goldman call this "The Ring Theory." Its guiding principle is "Comfort IN, dump OUT." That means a person's role is to give comfort and support -- and nothing else -- to anyone in a smaller ring than he or she occupies (here's an illustration). If a person needs to share his or her own worry or distress or debate or criticism (or personal philosophy), that's OK, "just do it to someone in a bigger ring."

While the Ring Theory may require exceptions to the rule, it's a brilliant starting place for orienting oneself before interacting with someone who is bereaved -- and I highly recommend it.

An excellent resource is now available to help employers respond effectively when an employee dies by suicide. The resource, "A Manager's Guide to Suicide Postvention in the Workplace," is aptly subtitled "10 Action Steps for Dealing with the Aftermath of a Suicide" and is available as a free download. The Guide begins with a clear definition of the word postvention, a term unfamiliar to many people outside the suicide prevention field:

Postvention is psychological first aid, crisis intervention, and other support offered after a suicide to affected individuals or the workplace as a whole to alleviate possible negative effects of the event.

The Guide outlines the vital roles managers play when a crisis situation occurs in a workplace, including fostering effective communications, providing helpful resources, and setting an example for employees. The 10 action steps are designed for implementation in any work setting, and the Guide concisely explains the rationale for each step, illustrates its implementation, provides a checklist of substeps, and points to authoritative resources supporting its recommendations.

It also includes templates to guide employers in communicating news of a death to employees and to the public.

The Action Steps are:

As I wrote in my last post regarding the recently released DSM-V revision eliminating the bereavement exclusion for depression, "this dialogue and debate will be ongoing." Hopefully, the discussion will be constructive and solution-oriented, and I'd like to contribute to it -- in that spirit -- whenever possible, so I am responding to the invitation of Donna Schuurman, Executive Director of the Dougy Center, to share "When Does a Broken Heart Become a Mental Disorder?" with readers of the Grief after Suicide blog.

The document, created only a week ago by an ad hoc group at a meeting of the International Work Group on Death, Dying and Bereavement, protests what Schuurman calls (in her comments to the American Association of Suicidology listserv, where she posted it) "the trend to pathologize grief" by outlining the three main points in the argument against eliminating the bereavement exclusion (namely, grief is not depression; antidepressants are already overprescribed; and most antidepressants are prescribed by primary care practitioners who, it is feared, will misprescribe them to bereaved people).

Below is an excerpt from my response to Donna on the AAS listserv, which summarizes both the argument in favor of the exclusion and my point of view about the matter, lists a couple of resources I have found to be helpful, and takes a run at framing the debate in the larger context of what I allude to as problems related to the "DSM 'industry'":

"Survivor Showcase" is an occasional feature on the Grief after Suicide blog, highlighting the personal stories of survivors of suicide loss (and other bereaved people) whose experiences with grief and recovery have been reported in the news.

This edition of "Survivor Showcase" begins with a story from a journalism class at Wenatchee (Washington) High School. Reacting to an article in the town's newspaper titled "Suicide Coalition Shows Us How to Solve a Crisis," Brenna Visser, opinion editor for the school newspaper -- whose 21-year-old brother died by suicide last summer -- writes:

This obviously caught my attention, mostly for the word "solve." Solve, as if the complexity of someone's pain were to be decoded like a Rubik's Cube ... Every case is individual: Why my brother died, and why Mr. Riggs' son has died, and every other suicide, has its own story. And for everyone who has felt that loss knows that this crisis is far from "solved"...

Brenna's faculty advisor, Dave Riggs, a survivor of his son's suicide, also weighs in -- then the two of them write:

We are treating suicide as the problem when it is the unbearable pain that a person experiences that is need of a solution. We can't "solve" a problem until we realize what the real problem is, and that is the complex way pain manifests within someone. There may not be a universal answer, but universal acknowledgement, kindness and respect for those who are struggling is imperative. Until we start dealing with the deeper issues, like mental illness, stress, etc., then there will be no improvement.

The American avant garde artist Andy Warhol said everybody gets 15 minutes of fame, and while I'm having my time in the spotlight, I want to share my words of gratitude with people to whom I am connected (because the theme of the entire affair is actually connection). The American Association of Suicidology honored me last week with the 2013 Survivor Recognition Award,* which "recognizes the efforts of one special survivor every year ... [who] used their own loss and grief to provide comfort and encouragement and healthy role-modeling to others bereaved by suicide in their community, state, or nation." I'd simply like to post my acceptance speech here, and leave it at that:

I ... didn't know how to say how deeply thankful I am in just a few words, so I thought I would try to explain what my intention has been in all this time -- for however imperfect I've been at accomplishing it, this is what I've tried to do:

I've tried to make my words and actions on behalf of survivors and on behalf of suicide prevention ... represent my gratitude for the great healing that has come to me over this almost 35 years now since my father killed himself. I've literally tried to carry in my mind and in my heart the entire web of relationships that make up my experience over those many decades ... and that awareness of the web of relationships that we are in has ... shown me how we are truly all connected. I've come to know that whatever happens to one of us, affects us all. So what I have ... tried to do is just to be compassionate toward the person who is in front of me in the moment -- because that's really all I can do. But I've found that that makes all of the difference in the world sometimes, not just to the person in front of me, but sometimes it makes all the world of difference for me -- and truly it is what I believe might change our world.

I also want to thank the fellowship of the American Association of Suicidology -- for all of you collectively and many of you individually have ... contributed to the meaning that I have found from my father's death and made me able to apply it in my own life. In one way or another, I ... do love each and every one of you, and that comes from many, many places, many sources -- but basically I simply believe that we're all in this together ... We are all in this together, and I am so, so grateful for the work we share. The goal that we are striving toward is to alleviate the pain and suffering ... that causes people to die by suicide and that we suffer in the aftermath of suicide -- and what a noble cause.

What was the worst imaginable nightmare -- truly an event that broke not only my heart but my spirit -- from that event has come a fantastically powerful positive force that I cannot explain, but that I am infinitely grateful for.

So I would just like to thank you one and all for this great honor. I will ... cherish this moment for the rest of my life. Thank you so much.

*(To learn more about the award and see a list of past recipients, go here, and to read my short bio, go here.)

I was on a panel at the American Association of Suicidology (AAS) national conference last week in Austin, Texas, that introduced new guiding principles for Suicide Bereavement Support Groups (SBSG) in the United States. The guiding principles were developed by an AAS work group last year, and have been approved by the AAS board of directors. These guiding principles provide a starting place for the development of best practices for support groups designed to help people who have lost a loved one to suicide cope with their grief.

Work group chairperson Doreen Marshall of Argosy University facilitated the presentation in Austin on Saturday, and she was joined by me and fellow work group member Susan Beaton of Australia's Beyond Blue.* According to Marshall, the work group intended for the principles ...

... to be less prescriptive, easy to implement, and require few resources ... We felt it was ... important to develop guiding principles by which survivors could ... evaluate the groups they were leading and attending in addition to providing some guidance toward best practices.

Beaton, who played a role in the development of Australia's support group standards -- on which the AAS guiding principles are based -- said many lessons are being learned as the field of suicide grief support increasingly focuses on strengthening the effectiveness of support groups and other services. Her aspirations include ...

... further research ... to determine types and modalities of suicide bereavement support related to better client outcomes, ... a national community of practice for SBSG facilitators, ... [and] funding ... for ongoing evaluation.

After the recent suicide of Matthew Warren, 27-year-old son of Christian evangelical minister Rick Warren, coverage of the point of view Christianity holds on suicide was widespread.

In a Washington Post story, Henry Davis, leader of the evangelical First Baptist Church of Highland Park in Landover, Md., said,

When people suffer despite prayer and consider therapy, "people think: 'Is this a knock against my faith? Am I not believing in God enough? Now I have to resort to this?' ... "I believe God is in therapy. I believe God can be in medicine. If someone says, 'I'm just going to pray,' you have to do more."

In a post on RevGalBlogPals, Presbyterian minister Mary Robin Craig shares the story of her 24-year-old twin son's death by suicide in 2008:

Our pastors were a tremendous help to us in their calm response, in their willingness to discuss suicide openly and candidly, and in their help in creating a beautiful service ... in which the cause of death was openly recognized, in which we were assured of the gift of resurrection, and in which the young people in the congregation were directly addressed.

A recent study published in the British Journal of Psychiatry on the views of people bereaved by suicide regarding news coverage of a suicide fatality found that currently available media guidelines for appropriate coverage of a suicide may not adequately take into account the needs of survivors of suicide loss.

[There is] a tension, and a difference of emphasis, between guidance for the press based on strategies to prevent copycat suicides (especially avoidance of certain details) and the perspectives of bereaved people (who feel they have a right to expect sympathetic and accurate reporting). There is a tension between a guideline that suggests that certain information should be withheld/not disclosed and a perspective that favours (in reports of an individual case) an accurate account, which may include such information (such as an image of the person who died).

At issue is the fact that ...

... systematic reviews of the literature have concluded that suicide rates may rise after media reports of suicide, especially if the dead person was a celebrity, if the report glamorises the suicide, if reporting is prominent, or if the method of suicide is discussed in detail.

Of course, those findings have influenced the media guidelines issued by suicide prevention proponents (see the U.S. guidelines), and the importance of preventing copycat suicide is paramount; but the bereaved's concerns about news reports of suicide also ought to be taken into account. The study of survivors showed that some want to share their story through news reports but others do not, so it would be helpful to have information and assistance readily available to the newly bereaved -- including how to take care of their own needs and what impact news coverage has on suicidal behavior -- so they can make make informed decisions about talking with the media.

I presented an experiential workshop for survivors of suicide loss -- titled "Suicide Bereavement: Personal Meanings"¹ -- at the Massachusetts Suicide Prevention Conference last week, and of the 17 people who attended, two identified themselves as clinicians who are survivors of a client's suicide. I am very pleased that they chose to attend, because the definition of "survivor" ought to be broad enough to include anyone who has been deeply affected by a suicide. For many clinicians, a client's death by suicide certainly causes profound grief, and they deserve compassionate support for their bereavement no less than any other "category" of survivor does.

Thankfully, there is a comprehensive resource available for clinicians who lose a client to suicide, the Clinician Survivor Task Force website,² maintained by John McIntosh for the American Association of Suicidology. The task force provides ...

... consultation, support and education to psychotherapists and other mental health professionals to assist them in understanding and responding to their personal/professional loss resulting from the suicide death of a patient/client and/or family member.

"Survivor Showcase" is an occasional feature on the Grief after Suicide blog, highlighting the personal stories of survivors of suicide loss (and other bereaved people) whose experiences with grief and recovery have been reported in the news.

This installation of "Survivor Showcase" begins with the links to a recent in-depth series on survivors of suicide loss from the Argus Leader (Sioux Falls, S.D.):
• Son's Torment Stayed Hidden, Parents Say
• Faith Provides Comfort Amid Anxiety for Sister
• Mother Turns Focus to Mental Health Help
• Comfort Can Be a Hug, If You Can't Find the Words
• From Guilt and Anger to Helping after Dad's Death
• "It's Just too Much to Carry by Yourself"
• Parents of College Student Feel Love, Wrenching Pain, Sadness
• "You Can't Beat Yourself Up," Farm Widow Says
• Sharing Provides Healing, Hope for Those Suicide Left Behind

Sherry Proudfoot, a high school teacher in Vancouver, B.C. who lost her nephew to suicide in 2009, is joining forces with the Josh Platzer Society for Teen Suicide and Awareness to raise funds and promote running as a resilience-building activity, according to a recent report in The Province. Jude Platzer, who founded the Platzer Socitey after her 15-year-old son died by suicide, told the newspaper:

"You never know who this hits. If one kid is depressed or one kid is worried about a friend, and they talk to someone ... and it turns him around, it's so worth it ... If we could have (gotten) my son through a couple years, I think he would have been OK."