"The Nature of Suicide Bereavement" is excerpted and adapted from "Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines" (2015), by the Survivors of Suicide Loss Task Force (http://bit.ly/sosl-taskforce) of the National Action Alliance for Suicide Prevention. The original document is available free for download at http://bit.ly/respondingsuicide.
The Grief After Suicide blog post related to this essay is at http://bit.ly/griefunique.
This brief presentation comprehensively covers the fundamental nature of suicide bereavement and offers basic guidelines for coping with grief after suicide.
This brief presentation comprehensively covers the fundamental nature of suicide bereavement and offers basic guidelines for coping with grief after suicide.
Suicide, it’s importance, global burden, burden of suicide in India, theories of suicide, it’s prevention, psychiatric co-morbidities associated with suicide, its treatment
Suicide Risk Assessment and Interventions - no videosKevin J. Drab
An in depth presentation of the current information known about suicide and the most effective interventions we currently have. If you are unclear about how to handle suicidal behavior or what are the more research-based approaches this PPT will be an excellent review for you. I have been training clinicians in Suicidology for over 20 years and have always stayed on top of the latest research and literature.
What is suicide? It is discuss in this presentation.
This slide covers theory and types of suicide, what are the reasons of suicide? What are the impacts of suicide?
Suicide prevention and role of media in preventing suicide also discuss in this presetnation.
It is a social philosophy of freedom, unfreeom, life, death & suicide. A PPT version of my paper "suicide as unfreedom & vice versa". Simpplified version of the paper.
Suicide, it’s importance, global burden, burden of suicide in India, theories of suicide, it’s prevention, psychiatric co-morbidities associated with suicide, its treatment
Suicide Risk Assessment and Interventions - no videosKevin J. Drab
An in depth presentation of the current information known about suicide and the most effective interventions we currently have. If you are unclear about how to handle suicidal behavior or what are the more research-based approaches this PPT will be an excellent review for you. I have been training clinicians in Suicidology for over 20 years and have always stayed on top of the latest research and literature.
What is suicide? It is discuss in this presentation.
This slide covers theory and types of suicide, what are the reasons of suicide? What are the impacts of suicide?
Suicide prevention and role of media in preventing suicide also discuss in this presetnation.
It is a social philosophy of freedom, unfreeom, life, death & suicide. A PPT version of my paper "suicide as unfreedom & vice versa". Simpplified version of the paper.
"New Perspectives on Suicide Prevention" Behavioral Healthcare Magazine Exclu...David Covington
Dennis Grantham feature article “Dispelling the Myths about Suicide” provides the three myths about suicide that Magellan Health has tackled in its Maricopa County contract.
Suicide: Risk Assessment and InterventionsKevin J. Drab
Suicide: Risk Assessment and Interventions; assessing suicide; suicide; killing oneself; death by suicide; indirect suicide; dynamics of suicide; self-harm; suicide survivors; psychological autopsy; commonalities of suicide; protective factors suicide; suicide risk; suicide prevention; suicide prediction; risk factors suicide; suicide risk categories; Collaborative Assessment and Management of Suicidality (CAMS) method; Suicide Status Form (SSF); motivational interviewing and suicide; Common Errors of Suicide Interventionists; contracting for safety; completed suicide; died by suicide; suicide prevention; self injury; guns and suicide
Suicide:Risk Assessment & InterventionsKevin J. Drab
Suicide: Risk and Interventions - a review of recent advances in suicidology and the use of Jobes' CAMS approach to suicide intervention and prevention.
Understanding suicide and Crisis Intervention Muskan Hossain
Defining Suicide
Suicidal Ideation
Suicidal Ideation in Young Children
SUICIDE INTENT SCALE
Psychology and Psychopathology of Suicide
NEUROBIOLOGICAL PATHWAYS LINKED TO SUICIDE RISK
MIND OF A SUICIDAL PERSON
The Media Presentation of Suicide
Case Studies
Prevention of Suicide
Prevention of Suicidal Ideation
Crisis Intervention Of Suicide
Treatment of Suicidal Ideation
World Suicide Prevention Day
BOOKS ON SUICIDE AND CRISIS INTERVNETION
Coping with Overdose Fatalities: Tools for Public Health WorkersFranklin Cook
Created by Franklin Cook of Unified Community Solutions for the Massachusetts Bureau of Substance Addiction Services, "Coping with Overdose Fatalities: Tools for Public Health Workers" covers basic practices that are likely to be helpful to frontline service providers in the immediate aftermath of a death from substance-use-related causes. It includes principles for agencies to consider and practical information about acknowledging death in the moment, coping with strong emotions, building a support system, getting extra support, and understanding this kind of grief.
Primer on Grief After a Substance-Use DeathFranklin Cook
This two-page handout lists a number of resources related to grief after a death caused by substance use -- and outlines basic information about the experience of bereavement for people who survivor a substance-use death.
Jerry elsie-weyrauch national-strategy-article-2002Franklin Cook
An article in a SAMHSA newsletter from 2002 that tells the story of the first U.S. National Strategy for Suicide Prevention (2001), which begins with Jerry and Elsie Weyrauch founding the Suicide Prevention Action Network (SPAN USA).
Enigmatic Nature of Suicide May Answer the Question "Why?"Franklin Cook
This brief essay suggests that specific aspects of suicide demonstrate that in a very real way suicide is inexplicable -- and claims that survivors of suicide loss who carefully consider this idea may be relieved of the distress they feel over being troubled by the question "Why?"
Aftermath of Suicide: Research Principles & PrioritiesFranklin Cook
Strategic Direction 4, Surveillance, Research, and Evaluation, excerpted from Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines. See http://bit.ly/principlescan for a blog post on the document.
Systems Must Include Three Levels of Care for Aftermath of SuicideFranklin Cook
A summary of how care-delivery systems, individual organizations and agencies, and service providers can address responding to a suicide in a way that meets the needs of everyone exposed to the fatality, both immediately and over the long-term. This is essential reading for leadership, strategic planning, and program development. The blog post on "Grief After Suicide" about this report is at http://bit.ly/systemshelp.
Resources: Coping with Grief, Trauma, & Distress After a SuicideFranklin Cook
PLEASE DOWNLOAD THE DOCUMENT FOR A COPY WITH ACTIVE HYPERLINKS.
This directory briefly describes 100 resources to help people affected by a suicide fatality -- and provides a link to each of the resources. It includes a great deal of information specifically for caregivers and others interested in helping the suicide bereaved. The directory also lists 36 recommended books about the aftermath of suicide. An online version of the directory is available at http://bit.ly/afterasuicide.
Impact of Suicide on People Exposed to a FatalityFranklin Cook
"Impact of Suicide on People Exposed to a Fatality" is excerpted and adapted from Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines (2015), by the Survivors of Suicide Loss Task Force (bit.ly/sosl-taskforce) of the National Action Alliance for Suicide Prevention. The original document is available free for download at bit.ly/respondingsuicide.
This summary report concludes that:
The research delineated above represents the solid and growing body of evidence that, for a significant number of people exposed to the suicide fatality or attempt of another person, there are long-term, harmful mental health consequences. Shneidman’s declaration (1972) that postvention is prevention for the next generation is unquestionably supported by clear and overwhelming evidence that exposure to the suicide of another person, particularly of a close intimate, elevates the risk of suicidal behavior and of death by suicide in the population of people exposed.
The Grief After Suicide blog post related to this essay is http://bit.ly/impactessay.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. 1
"The Nature of Suicide Bereavement" is based on Responding
to Grief, Trauma, and Distress After a Suicide: U.S. National
Guidelines (2015), by the Survivors of Suicide Loss Task Force
(bit.ly/sosl-taskforce) of the National Action Alliance for
Suicide Prevention. The original document is available free
for download at bit.ly/respondingsuicide.
The Nature of Suicide Bereavement
Special report❋
It is intuitively obvious—and clinically confirmed—that for at least some
individuals, the suicide of someone they know has a significant and
deleterious effect on their functioning. Nonetheless, while there has been
and continues to be debate among academics, researchers, and clinicians
about whether and in what ways bereavement after suicide is different from
bereavement after other forms of loss (Jordan & McIntosh, 2011b), the
personal narratives of countless loss survivors make it clear that, for them
at least, suicide has had a transformative effect on their lives (Rappaport,
2009; Stimming & Stimming, 1999; Treadway, 1996). It appears that there are
some aspects of bereavement after suicide that share elements with other
forms of loss, particularly other traumatic deaths such as homicide (Currier,
Holland, & Neimeyer, 2006; Murphy, Johnson, & Lohan, 2003; Murphy,
Johnson, Wu, Fan, & Lohan, 2003; Vessier-Batchen, 2007). Nonetheless, it is
reasonable to assert that there are aspects of suicide bereavement that are
either characteristic of only suicide, or that are likely to be more prominent
as a result of suicide than from other causes of death. Importantly, any
formulation about the impact of suicide in the end generates empirical
questions that, if answered, could lead to targeted responses that would
greatly relieve the suffering of people exposed to suicide.
Suicide Is Distinctive
First, suicide bereavement is unique because suicide itself is a singular
manner of death. This is a vital but overlooked perspective, which 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?” Logically, there are several aspects of death by
suicide that seem likely to influence the experience of suicide loss survivors.
Suicide creates ambiguity about the volition of the deceased. Depending on
the circumstances leading to the death, suicidal volition can be understood
as existing along a continuum from a “clear and free choice” (someone with
a terminal illness who chooses physician assisted suicide) to “not a choice at
all” (someone with schizophrenia who hears command hallucinations telling
❋
The source document for this report is Responding to Grief, Trauma, and Distress
After a Suicide: U.S. National Guidelines, by the Survivors of Suicide Loss Task Force
of the National Action Alliance for Suicide Prevention. The use of the Action Alliance
logo is intended to credit the SOSL TF as the author of the source document.
April 26, 2015
2. 2
them to “kill the demon in you”). Various people commonly take different
viewpoints about the role of volition in any particular suicide. Some might
believe that the thinking of the deceased has to have been severely impaired
and death could not have been a rational choice (Wrobleski, 1999). It has
been said, for instance, that a person dying of suicide dies against his or her
will, as does the victim of physical illness or accident (Rolheiser, 1998).
However, to even meet the definition of suicide, the deceased must have
taken purposeful action to cause their own death (Andriessen, 2006).
Ultimately, what is crucial to the experience of grief is the loss survivor’s
perception of the degree of choice in the death, a matter that is often
analyzed in excruciating detail by the bereaved. For suicide loss survivors,
their belief about the deceased’s volition often becomes a central feature of
their grief—and can have a profound impact on the meaning they attribute
to the death (Sands, 2009; Sands, Jordan, & Neimeyer, 2011). On one hand,
for example, when the behavior of the deceased is perceived as a choice by
the survivor, it may lead to struggles with powerful feelings of rejection,
abandonment, or anger. On the other hand, when a survivor believes the
deceased had no choice (e.g., because of severe depression), then he or she
may be comforted by the idea that his or her loved one died of an illness.
Suicide is characterized as preventable in the population. Of course, broadly
communicating the idea that suicide is preventable is essential to the public
health approach to reducing suicide. However, this message can also
contribute to the perception that if suicide in general is preventable, then
every suicide is preventable, and therefore, “my loved one’s suicide could
have—and should have—been prevented.” This perception (whether it is
from the loss survivor’s or from another’s perspective) can add greatly to
the suffering of the suicide bereaved. As with the issue of choice, the
preventability of individual suicides exists along a continuum (from not at
all to unquestionably preventable). A survivor’s view of whether the suicide
was preventable or not—at any point during the deceased person’s life—can
propel their grief experience in one direction or another. If a suicide is seen
as being clearly preventable, then the bereaved may blame others or
themselves; feel guilty or ashamed about their “role” in the death; or
experience intense anger at others, at themselves, or at God. If, however, a
suicide is seen as not at all preventable, survivors may have any number of
reactions, ranging from relief (that the deceased’s pain has ended) to despair
and helplessness (because nothing could have been done).
Suicide is stigmatized. The stigma historically associated with suicide in
most Western societies comes from the belief that suicide is criminal or
sinful, a sign of character weakness or the result of evil forces in possession
of the individual (Colt, 2006). By extension, the family of someone who dies
by suicide has also been viewed as tainted or culpable, and therefore,
deserving of being shunned or punished. In contemporary times, there is
probably less outright condemnation of suicide, but harsh, institutionalized
judgments from the past have left a lingering discomfort for many people
regarding how to respond in a supportive way to the suicide bereaved.
Although societal views are changing, suicide stigma continues to be a
powerful and active force in interactions between loss survivors and their
communities (Cvinar, 2005). Research suggests, in fact, that stigma
3. 3
negatively affects the tendency of people bereaved by suicide to seek help,
the strength of their social connections, and their sense of isolation
(Armour, 2006; Feigelman, Gorman, & Jordan, 2009; Feigelman, Jordan,
McIntosh, & Feigelman, 2012; Sveen & Walby, 2008). When stigma
contributes to a lack of support or sympathy—or to unkindness or even
cruelty from other people—it can contribute to secondary wounds that may
have a profound impact on loss survivors.
Suicide is traumatic. Death by traumatic means is not uncommon, including
homicide, accidental injury, medical emergency, war, terrorism, and natural
disaster. Suicide is arguably an inherently traumatizing way to die because
its victims must develop and put into motion an immense psychological
force in order to accomplish the task of destroying themselves. The
magnitude and intensity of this self-destructive energy must overcome the
biological drive for self-preservation (Joiner, Van Orden, Witte, & Rudd,
2009). Even if this occurs in small steps, incrementally over time; even if it
appears to be a passive act of giving up on life; even if a disorder such as
depression is fueling the person’s demise; even if the lethal action taken
involves only “going to sleep”—the process of negating one’s life in this way
can be construed as an act of violence against the self. When the death of a
loved one involves trauma, there is a chance that whatever violence befalls
the deceased will traumatize the bereaved.
Survivors of suicide loss potentially are affected by three sources of trauma:
• Psychological trauma: The bereaved might reconstruct and brood over
the psychological pain the deceased experienced and over the
psychological force that was required for the deceased to kill himself
or herself.
• Direct exposure: They might have witnessed the suicide, discovered
the body, or been exposed to the death scene or to artifacts from the
aftermath, such as personal belongings, an autopsy report, etc.
• Imagined exposure: Even when the survivor is not a direct eyewitness
to the death, many survivors create—and some are captivated by—a
mental image of what the dying process was like and what the
deceased suffered as he or she died.
All that has been described above as unique aspects of dying by suicide may
come into play in other modes of death or trauma. It seems clear, however,
that there are qualities related to the volition, preventability, stigma, and
trauma of suicide that generate in the bereaved particular kinds of emotional
reactions or certain patterns of reflection or mental struggle. Therefore,
these forces at work in a death by suicide are likely going to color the
bereavement experience that follows in its wake.
Aspects of Grief Accentuated by Suicide
In addition to these more or less distinctive aspects of suicide, many other
grief responses that are often more pronounced or intense after suicide have
been identified (Jordan, 2008, 2009; Jordan & McIntosh, 2011a). Noting that
these themes can be present in grief after other kinds of death, Jordan and
McIntosh (2011b) point out that suicide bereavement is most different from
4. 4
grief after a natural death; somewhat different from grief after a sudden,
unexpected death; and most similar to grief after a traumatic or violent
death, such as homicide (p. 36, emphasis added). In delineating the common
themes after a suicide, Jordan and McIntosh also strongly emphasize that
“many (but not all) people bereaved by suicide will manifest many (but not
all) of these themes, reactions, and features” (p. 30). Below is a discussion of
each of the themes.
Shock. Suicide is often (although not always) sudden and unexpected. Loss
survivors often experience it as unfamiliar and unnatural—as being
fundamentally wrong in one way (bad or punishing) or another (out of the
natural order, unacceptable). As mentioned, the violence associated with
suicide can be overwhelming, and its personal impact on survivors can be
similar to that of any abrupt event, such as a natural disaster or accidental
death. Suicide is often the concluding event of an ongoing crisis for the
deceased and, simultaneously, the initiation of an altogether new crisis for
the bereaved.
Disbelief. A common reaction to any sudden death is “I can’t believe it,” for
it is difficult to grasp and absorb such a profound and not-planned-for
occurrence. With suicide, there is often strong disbelief. It seems impossible
to some loss survivors that a person they knew intimately could have been
thinking of ending their life without the survivor being aware of it. It
violates the assumptive world or belief system that the bereaved had about
their loved one, themselves, and the world as they knew it. In addition, there
can be denial that the death was by means of suicide, which is often
relatively short-lived but for some, may endure for a lifetime.
Asking “Why?” Death by any means often compels the bereaved to consider
the deepest existential questions about life, death, and why certain things
transpire. With suicide, the search for the answer(s) as to why their loved
one died is central to the experience of many loss survivors. The complexity,
troubling nature, and frequent absence of the answer(s) can be a heavy
burden for the suicide bereaved. It is not unusual for loss survivors to feel
compelled to conduct their own personal inquest or psychological autopsy
into the death, focusing on learning as much as possible about what led to
the death; the mental state of the deceased; and when, where, and how their
loved one died. The bereaved might also be preoccupied with discovering
who knew what, who saw what, who did what, etc. Finding answers, and/or
accepting the elusiveness of those answers, is commonly a difficult but
necessary part of the journey for the bereaved by suicide.
Shame. References to stigma elsewhere in this essay help to explain the
feelings of shame that befall many loss survivors. They may struggle with
the moral standing of their deceased loved one, or of themselves (good vs.
bad). This can include constructions about the deceased’s eligibility for
redemption (heaven vs. hell, forgivable vs. unforgivable), character (strong
vs. weak, selfish vs. generous, cowardly vs. courageous), normality (“crazy”
vs. sane), and value (significant life vs. wasted life). Shame also can be
exacerbated by other themes, especially feelings of self-blame, guilt, and
perceived abandonment by the deceased. Police, fire, military personnel and
others who place a high distinction on the way a person dies in service can
5. 5
be affected by real and/or perceived stigma related to suicide. A death by
suicide may be seen as negating all other characteristics of the deceased,
even noble or honorable ones.
Blame. It is common for the bereaved to assign responsibility for their loved
one’s death to a particular person, event, or circumstance. They might ask,
“Is my loved one responsible?” “Am I responsible?” “Is God responsible?”
Assigning responsibility can also be driven by the loss survivor’s need to
make sense of the incomprehensible. Blaming can be understood as a means
of restoring a sense of order in the world—and of protecting the self from
feelings of self-blame.
Guilt. People bereaved by any kind of death might feel guilty about what
they believe they should, would, or could have done or not done to prevent
the death. The answer many survivors of suicide loss arrive at when they ask
“Am I responsible?” is “Yes.” People naturally believe in the power of their
love and caring to protect their loved ones. In the case of suicide, it is not
unusual for people to believe that this power “should” have been able to
save their loved one’s life. And in hindsight, they may be able to see actions
that could have been taken (or avoided) that might have made a difference.
This can contribute to a powerful kind of “magical” or counter-factual
thinking about the preventability of the death that can haunt loss survivors
for a very long time. There are also instances where a survivor points to a
single—and even factual—event that preceded the suicide (“We had a fight”;
“I left him alone”) and insists on a simple causal connection between that
event and the suicide, even though suicide is multi-causal—involving
numerous interrelated contributing factors—and in its essence is a very
complex and enigmatic human behavior.
Abandonment and rejection. It is common for bereaved people to feel “left
all alone” when someone dies of any cause. Suicide is sometimes seen as the
most powerful form of abandonment or rejection possible, because from the
point of view of the bereaved, the deceased “chose” death over continuing to
live in relationship with the survivor (see the section on volition, above). The
suicide bereaved may also feel that the deceased avoided the opportunity to
reach out to them or rejected help that was offered. These feelings of
abandonment can, in turn, lead to strong feelings of anger at the self (i.e.,
guilt) or anger at the deceased.
Anger. Anger is often caused by feelings of guilt, blame, abandonment, and
preventability. The Latin root of the word suicide means “self-murder,” and
in some ways, the reactions of suicide loss survivors can resemble the
reactions of homicide survivors, who are often enraged with the perpetrator
of the murder. The profound conundrum with suicide is that the
“perpetrator” and the “victim” are one and the same person. This can make
for a very conflicting and confusing set of emotions for the bereaved, which
are not easily resolved. Another link between anger and suicide is that the
survivor might feel angry about “secondary losses,” such as being left to
raise children without a spouse, facing financial difficulties, or living
unaccompanied through retirement.
6. 6
Fear. Besides the fears that accompany all kinds of deaths—such as fear of
being alone or of financial insecurity—the bereaved by suicide often fear
that they or another family member or friend will also die by suicide. The
conviction that suicide could happen to anyone, or that suicide “can come
out of the blue,” can leave loss survivors wary and hypervigilant over the
safety of other loved ones. Fear and hypervigilance can be particularly
troublesome for clinicians who have lost a client to suicide.
Increased risk of suicide. In their seminal book on suicide bereavement and
caring for loss survivors, Jordan and McIntosh (2011c) conclude:
Compelling evidence now shows that exposure to suicide carries
with it the risk for a number of adverse sequelae. Perhaps the most
disturbing of these risks is the elevated likelihood for suicide in a
person exposed to the suicide of another individual (p.11).
This creates a challenge in supporting loss survivors, for it is surprisingly
common for the suicide bereaved to express the wish to die in order to
escape the pain of their loss or to join their loved one in an afterlife. It is
vital, therefore, to determine whether anyone speaking of dying or of killing
themselves is at risk for suicide, including ensuring the person’s safety and,
if necessary, making a prompt and effective referral of the person to a
competent mental health professional for a thorough clinical assessment.
Relief. Suicide sometimes marks the end of a long and grueling period in
which a family is constantly in turmoil over a person’s mental illness,
substance abuse, and/or other stressful, painful, or even unmanageable
situation. They may have been on a prolonged “suicide watch” with the
deceased. Or, as a result of a psychiatric disorder or other condition, the
deceased may have been difficult, exhausting, or abusive to live with. Or it
may simply have been very distressing to watch the loved one struggle with
his or her emotional and life problems. In such instances, it is natural for
loss survivors to feel relief that the ordeal is over. However, this feeling can
be troublesome, contradictory, and confusing, because it is judged by others
and/or by the survivor himself or herself to be unacceptable to experience
relief that someone has died. The bereaved also may feel reluctant or
ashamed to share their feeling of relief with others—and misunderstood if
they do disclose such emotions.
Finally, there are several modes of suicide that likely affect those exposed to
a fatality in particular ways, but about which there is little research on the
effects. Among these are murder-suicide (a suicide following a homicide),
double suicide or suicide pacts (suicides that are directly and purposefully
related to each other), and ambiguous death (the manner of death cannot be
definitively established).
7. 7
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