The short video Firefighters Coping with the Aftermath of Suicide takes an intimate look at how suicide affects firefighters, both because they respond to suicide attempts and fatalities and because suicide strikes among their own ranks.

Please share the video with your local fire department (here's the short URL: youtu.be/QSH5EbNhJBA) and encourage firefighters to watch it (it's 11 minutes long).

In the video, Gretta Flatt, a firefighter with South Metro Fire Rescue near Denver, Colo., tells the story of a horrific suicide she and fellow firefighters responded to that triggered distress in her from a long career responding to traumatic incidents:

This is a prime example where I was not aware of how that would affect me personally. This particular call ... is really a hotbed .. I am at the latter part of my career, so it's like things are showing up out of the blue, and I have read about that, but it can really happen.

This year's final post on the Grief After Suicide blog features what I believe is an extraordinarily wise reflection on grief from Dr. Robert Neimeyer, a world-renowned expert on bereavement who is also a suicide loss survivor (shortly before his 12th birthday, Neimeyer's father died by suicide). His comments were recorded for an AfterTalk radio special shortly after the Paris terrorist attack on November 13.

A listener notes that "terror is the trigger for my grief and sadness" and asks how people might best respond to that dilemma. In reply -- while touching upon how acts of public violence can affect both the broader society and individuals who have experienced traumatic grief -- Neimeyer says:

I don't think that the pain of grief is often the problem. The pain that is problematic is that which complicates grief ... for example, when our own sense of rage or injustice begins to dominate to a point that we don't give space to the sadness [and] space to the mourning ...

He points out that his observation isn't about only terrorism but also about traumatic loss "in our own personal lives." Certainly, I would say, this applies to how various emotional reactions associated with a suicide can interfere with a person's feeling of pure grief over the death itself. (For more on emotional reactions to suicide, please see "Suicide Grief Is Unique Because Death by Suicide Is Unique.")

Suicide loss survivors may, then, benefit from the advice with which Neimeyer concludes his answer:

I think that a first step might be to distinguish what is grief from what is not grief and to recognize that grief in the presence of suffering and loss is an appropriate response to a tragic circumstance ... to recognize that there can be complicating emotions and behavioral responses ... Sometimes the problem comes with seeking a hasty solution ... to a circumstance that really requires a longer-term response.

Neimeyer alludes to one requirement of a longer-term response being space for sadness and mourning. In 2016, the Grief After Suicide blog will be dedicated to helping people bereaved by suicide find, create, and share the healing space we need to focus on grieving our loss.

Self-compassion can be a potentially valuable skill for bereaved people to consider, and I believe I've found a simple exercise that I hope -- if it appeals to you -- will open the door to practicing self-compassion in a way that contributes to your healing.

The exercise -- the "Self-Compassion Break" -- can be found on Kristin Neff's website both as a written instruction and in an audio version. Clear, brief, step-by-step guidance is given on the website, which outlines three basic steps to pausing in the midst of a painful experience to invite self-compassion into the situation:

1. Be still for a moment and observe that you are suffering.
2. Recognize that your suffering is painful -- and also is part of being human.
3. Declare that being kind to yourself is your intention.

Why do I think this self-compassion exercise might be helpful to people who are grieving? Because there are times when the pain of loss touches us so deeply that it is not possible -- at least for a time -- to squelch our pain or to escape from it. And I hope that, if we are able to bear the pain and at the same time to be actively compassionate toward ourselves, we may begin to experience something meaningful beneath the pain -- or beyond it.

Please try the "Self-Compassion Break" -- perhaps beginning not with the most troublesome pain you feel but instead practicing with any kinds of difficult or stressful situations -- to see if it might hold value for you.

If self-compassion is an concept that resonates with you, here are some additional resources from Neff:

• "Self-Compassion Guided Meditations and Exercises"
• "The Three Components of Self-Compassion," a 6-minute video presentation (from which the illustration above is taken)
• "Self-Compassion: The Proven Power of Being Kind to Yourself," a 50-minute video interview with CJ Liu, about Neff's book on self-compassion
• "Why Self-Compassion Trumps Self-Esteem," an article from Greater Good: The Science of a Meaningful Life
• Self-Compassion on Facebook

I hardly know where to begin in heartily recommending the "Silent Suffering" series published today by the Columbus Dispatch. Each of its half dozen in-depth feature stories and handful of engaging videos is in itself worth experiencing. Taken all together, the series offers an extraordinary opportunity to see suicide from the perspectives of those who struggle with thoughts of killing themselves, of caregivers who are devoted to preventing suicide, of family members who are left behind to ask "Why?" and truly of everyone in a community who is affected by suicide.

Click on the picture above to go to a video that sets the scene for the entire series (the video features several moving stories from people's personal experience). My introduction to the series came when a colleague sent me the article "Some Survivors Cope with Loss by Helping Others Affected by Suicide," which tells the stories of people bereaved by suicide who now volunteer in a variety of ways that change -- and literally save -- the lives of others struggling with suicide and its aftermath.

I hope the following quote from the "Helping Others" story persuades folks to explore whatever might interest them in this superb series. These are the words of Mary Ann Ward of Columbus, Ohio, who lost her son Murray to suicide in 2009 -- and who now facilitates a support group for people bereaved by suicide.

“All we can do is accept this loss without ever understanding it, and lean on one another to move forward ... I can give hope to those who are newer than I. From the pain, we can grow in knowledge and wisdom, and experience joy again.”

I recently sent an essay to TAPS Magazine, which is going to be published in its upcoming edition; and I decided to recognize National Survivors of Suicide Day by sharing an excerpt from the essay here on the Grief after Suicide Blog. In the excerpt (you may download it here), I begin with this statement:

I believe the love we feel for a person who has died and the pain of grief we feel are directly and profoundly connected: When people die, our immense love for them is, in a way, the source of our pain.

Then I say that realizing the "pain following the loss of a loved one is a natural phenomenon ... can empower you to give yourself permission to express your pain." I call expressing your pain "a healthy response to the death of a beloved person," implying that such expressions are connected to the loving relationship between you and the now-deceased person. In fact, I declare, "the pain of grief can provide the 'fuel' for profoundly heartfelt discoveries ... [about] the meaning in your loss." I close the excerpt with a list of questions that I hope might help people cope with their pain, followed by this conclusion:

The pain of grief can be terrible, and there is often no sure way to stop pain from unfolding in real time. But finding safe ways to process your pain can help you see beyond it even as it has you in its grip. And reflecting on the connection between your pain and your love for the person who died can help you uncover meaning in your life that comes directly from the relationship you had -- and still have -- with your loved one.

By Franklin Cook

A recent blog post on Grief After Suicide argues (convincingly, I hope) that suicide bereavement is unique because suicide itself is a unique way to die. Yet, at the same time, an abundance of research -- not to mention the universality of the human experience of grief -- points to a paradox, namely, that all bereavement over the death of a loved one shares a great deal in common. In other words, grief after suicide is, simultaneously, both different than and similar to bereavement following other means of death.

Understanding and accounting for this paradox is important because, as is stated in recently released national guidelines on responding to suicide, created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention:*

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].

This emerging field would benefit tremendously from looking more closely at -- and acting more collaboratively with -- the field of grief counseling (as well as other fields, such as traumatology, mental health crisis response, and disaster response). Doing so would enrich and strengthen suicide grief support through the application of evidence-based and promising practices that are already proving to be effective with a variety of bereaved people. Taking this multi-disciplinary approach would prevent responses to suicide grief from evolving based on narrow or monolithic ideas centered primarily around what is unique about suicide bereavement.

By Franklin Cook

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:

First, that the bereaved are at a higher risk for suicide:

"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."

Second, that the suicide bereaved are at a higher risk for other negative outcomes:

"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."

Even though research on the effects of suicide loss is sparse (which will be the subject of a post later in this series), the report concludes that the United States should "move ahead nationally to strengthen programs, services, resources, and systems to help suicide loss survivors and others affected by a fatality."

By Franklin Cook

Perhaps the word unique is too restrictive in a discussion of universal phenomena such as death or grief, but according to new national guidelines* for responding to suicide, considering such a perspective ...

... 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?"

Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines suggests that death by suicide can raise questions about the deceased's volition and whether the death was preventable as well as about the role of stigma and of trauma in the death. The emotional reactions of loss survivors to a particular suicide, the argument goes, can be shaped by how each person experiences the death along the continua of it being willfull or not, preventable or not, stigmatized or not, and traumatic or not.

This idea is one of several fresh perspectives offered in the guidelines, which were created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention to advance a vision for reinventing postvention in America and creating ...

By Franklin Cook

A historic document, Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines, was announced earlier this month at the Association for Death Education and Counseling conference in San Antonio and at the American Association of Suicidology conference in Atlanta. The Grief After Suicide blog -- in an upcoming series of posts -- will cover a number of ways that this groundbreaking document is paving the way for reinventing postvention in America. For instance, the guidelines:

• Summarize research evidence showing that exposure to suicide unquestionably increases the chances that those exposed -- perhaps especially the bereaved -- are at higher risk for suicide as well as for numerous, sometimes debilitating mental health conditions
• Highlight the effects of a fatality on people beyond family members of the deceased, including friends, first responders, clinicians, colleagues, and others (even entire communities) who may require support in the wake of a suicide
• Describe a new framework for classifying people who experience a suicide (Exposed, Affected, Short-Term Bereaved, and Long-Term Bereaved) that will help focus research and guide the development of programs and services to meet the unique needs of specific populations (see the graphic at bit.ly/continuummodel)
• Advocate for a systems approach, through organizing interventions into three separate, overlapping categories:
    • Immediate Response: Based on mental-health crisis and disaster response principles
    • Support: From the familial, peer, faith-based, and community resources that help the bereaved cope with a death
    • Treatment: By licensed clinicians for conditions such as PTSD, Depression, and Complicated Grief
• Argue that suicide bereavement is unique because death by suicide is unique (i.e., it involves questions about the deceased's volition, the effects of trauma, the degree that suicide is preventable, and the role of stigma in people's treatment of the deceased and the bereaved)
• Present an outline of the research needed to expand and enrich what is known about suicide bereavement and other effects of suicide (which will lead to the development of evidence-based practices in suicide postvention)
• Assert that suicide grief support efforts ought to be informed by research and clinical advances over the past 20 years in the fields of bereavement support, traumatology, and crisis and disaster preparedness
• Include an appendix outlining numerous, practical resources for the suicide bereaved and those who care for them (please link to the expanded, online version of the resource clearinghouse)

---

An excerpt of the guidelines (Table of Contents, Executive Summary, Acknowledgements, Preface) is available at bit.ly/excerptsosl, and the complete document is available at bit.ly/respondingsuicide. The guidelines were created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention.

In "Suicide by Train: Shared Tragedies Upend String of Lives," Orange Country Register reporters Keith Sharon and Greg Hardesty have given us an intimate look at the circle of people affected when someone dies by suicide.

The story -- of a middle-aged man's suicide on a stretch of track in Southern California -- gives voice to those bereaved and shocked and debilitated by the death, the man's wife and friends, a passer-by who witnessed the suicide, train engineers, and a father who faced an irony too horrible for him to comprehend or assimilate.

It is a story that should be read from beginning to end without much of a hint about its details, so I'll share only a glimpse of the man's widow and his father:

"As I was driving in the rain to the hotel [after being told of the suicide], my first thought was that this is more than I will ever be able to handle," she said. "I contemplated slamming my car into the light pole ahead."

A year later, she has taken up "public speaking, going to high schools and anyone who would listen to her talk about mental health and how to handle depression." She reports, though, that her husband's father "has never been the same":

He's fallen twice in recent months, and he was unable to continue tending to his goats, so he sold the farm. He cut off his phone service.

"Sold the farm": What an awful but apt description of bottomless grief.

This story about suicide by train illustrates the long reach of suicide's aftermath in all cases, showing how deeply it touches even those one might not expect, an ex-girlfriend who relapses on alcohol and a stranger who needs trauma therapy -- people who come face-to-face with victims in their final moments. Suicide, we are reminded, wounds people near and far from the center of a deceased person's life, as tragedy reverberates outward from the scene of a person's death.