Suicide grief support is an emerging field of practice poised to gain strength from newer understandings of bereavement adaptation in thanatology [the study of death and bereavement].

"Determining how a particular individual might be categorized would not be linked to the person's designation, role, or relationship in reference to the deceased. Rather, each person's reaction to the death would determine the category into which he or she would be classified."

A recent summary report,* "Impact of Suicide on People Exposed to a Fatality," raises an alarm about negative effects some people bereaved by suicide suffer from their loss that go beyond their experience of grief. The report is available, below, to read or download. It delineates research evidence that substantiates two troubling facts:

"Clear and overwhelming evidence [shows] that exposure to the suicide of another person, particularly of a close intimate, elevates the risk of ... death by suicide in the population of people exposed."

"The elevated risk for suicidality is not the only adverse effect of exposure to suicide. Many studies have also found elevated rates of psychiatric disorders (particularly depression), social difficulties, and continuing grief reactions in the suicide bereaved when compared with other types of loss survivors or population-level norms."

... opens the door to asking not only "What makes grief after suicide different?" but also "How does the distinctive nature of suicide itself affect the bereavement experience of survivors?"

Policy makers will need to strengthen the responses of health and social care services to [the suicide bereaved] if they are to mitigate the clear risks of suicide and depression. Such efforts can minimise distress, improve productivity, and contain costs of health-care treatment.

Unified Community Solutions (my private consultancy) and the Carson J Spencer Foundation (Sally Spencer-Thomas's nonprofit organization) distributed the survey to help us explore developing more-effective programs and resources for suicide bereaved men. We are hopeful that by this summer, we'll have an idea about how we might begin making new inroads into supporting men bereaved by suicide.

Many of the rituals reported were not ... public ones ... Rather, they were private rituals. Only 15 percent of the described rituals had a social element (and just 5 percent were religious). By far, most of the rituals people did were personal and performed alone.

[These] rituals help people overcome grief by counteracting the turbulence and chaos that follows loss. Rituals, which are deliberately-controlled gestures, trigger a very specific feeling in mourners -- the feeling of being in control of their lives. After people did a ritual or wrote about doing one, they were ... less likely to feel "helpless," "powerless," and "out of control."

He calls his essay an "attempt to take a balanced view of the arguments for and against diagnosing Complicated Grief," and whether one agrees that his view is balanced, he does an excellent job of summarizing his topic, delving into everything from Holly Prigerson's and Kathyrn Shear's point of view to key ideas from authors featured in a recently published book of scholarly essays on Complicated Grief, which Wilson calls "a seminal collection of writing."

He thoughtfully covers the issue of what constitutes normal grief and grief from a traumatic death and identifies the features proposed to distinguish Complicated Grief from both, namely its intensity, duration, and effect on a person's functioning. He elaborates on this latter feature, which is most interesting to me -- for it is a person's ability to function in life that I rely on to determine if someone I am working with might need more assistance than I am able to offer.

The value of Wilson's essay, in part, is that it shows a clinician -- who is not also a researcher -- trying to grapple with the difficult questions of Complicated Grief (or not) and grief as a malady (or not). To his statement (which is, I believe, a paraphrase of Therese Rando's thinking) "it is the idiosyncratic, complex nature of all grief, normal and complicated, that defines the problem," I would add that the problem also lies in trying to answer such questions in a reductive way, which to me is the crux of the matter.

For practitioners, this concept reminds us of the importance of a client-centred approach rather than a reliance on textbooks to tell us what to expect, both in healthy and dysfunctional grief ... Clients are not there to fit into neat theories, they are individuals. We can and should learn about grief by listening closely to their human experience.

What do we know about the needs of men who are bereaved by suicide, and -- if, in fact, male survivors of suicide loss do have unique needs -- what is being done to meet those needs? The answer to the first question is that we know very little specifically about men's needs after they experience a loss to suicide (beyond what we know generally about grief after suicide, about the differences between men's and women's psychological make-up, and about their different styles of communication and help-seeking). The answer to the second question is that almost nothing is being done to meet the special needs of men who have lost a loved one to suicide.

Here is a personal story -- not about grief specifically but about "sharing emotions" -- that illustrates why it is important to find answers to these questions.

The first experience I had that marked me as a man in therapy (as opposed to a woman in therapy) was in early 1982 in an aftercare support group in Twin Falls, Idaho, which was designed to help people who had completed inpatient treatment for addiction make a successful transition back to the community after spending a month in an institution.