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October 2008

GRIEVING NOTES

BY Al Vigil

"You can't see the forest for the trees" is a very well known saying. I think that life can get to be like that sometimes.

There can be so many things going on in our lives, all at the same time, that our minds and hearts can jump around.

" I don't know what to think about next," is often heard at SOS (Survivors of Suicide) Grief Support meetings. Of course, especially at the early stages of grief work, the mind really is a jumble.

Your thoughts and emotions are changing from moment to moment.

You're not going crazy; it just seems that way.

It's been 24 years since our daughter Mia died, at the age of 18, and of course life still brings things about which we again have to ask ourselves, "what should I think about next?" Life is not going to change so much for us, that only one event is going on at once. So we have to try to learn to how handle and control our thoughts in a healthy and some-what sane manner.

We once had this discussion with our minister, the Rev. Mikel Taxer, when we lived in San Diego, California. He suggested something that worked with Linda and I. He led us into the five letter word —focus.

He suggested that we take a particular situation that we were dwelling on and just 'focus' on one and only one, particular aspect. Of course, we should 'focus' on one aspect that is the most important and the most meaningful, and thus the best solution possible to a particular event.

Focusing works. We had been doing it for years before we even gave it that particular definition. At the beginning of our grief with Mia, we focused on getting through a day at a time. Later it became getting through the Mia Memorial Service. After that it changed to the dedication of the Torrey Pine Tree in her name. Sometime after that, the 'focus' became other members in our family, and later even close friends.

When things come up that seem like a mountain, we remind ourselves of Rev. Mikel's 'focus.' We approach situations, we discuss all of the aspects, the positive ones and the negative ones, and we try to 'focus' on what the main and special reasons for our involvement to it are . That helps clear our attitude, our hearts and our minds, as we approach that situation. Deliberate 'focus' helps us to see things better, perhaps even to solve problems.

Can you imagine the impossibility of the woodsman if he was told to clear the forest and he was unable to focus on one tree at a time. Grief work, (and, yes, it is work) can be handled the same way.

As survivors we can 'focus' so that we can change, develop or enhance the life that is still around us —even after the loss of a loved one to suicide.


COPING WITH GRIEF DURING THE HOLIDAYS
By Al & Linda Vigil - Editors : Sharing and Healing

Within a three month period Americans celebrate the most popular Holidays of all: Halloween, Thanksgiving, Hanukkah, Christmas, and New Year. Those who are surviving the death of a loved one, must now face the festive period, missing a smiling face and seeing an empty chair at the celebration table. The hand that reached out and squeezed yours during a special moment of Thanksgiving or prayer, in previous years, is no longer there. A death has forever changed the meaning ...holiday season.

It happens this time every year and, like it or not, the holiday season is here. If you are grieving, the upcoming weeks may be filling you with anxiety and dread. Regardless of whether this is your first holiday after a loss, or if enough time has passed for you to feel stronger, and more optimistic about the future, here is a season that will require real "grief work.

"Holidays, birthdays, anniversary dates, etc. are especially difficult times," writes Lois Bloom in her book, Mourning After Suicide. "You tend to compare the past good times with sadness you now feel. The first year is usually filled with intense emotions, particularly stirred on special occasions. Plan ahead for special days." Both happy and sad experiences are deeply felt at this time. 'Bittersweet memories,' are some of the best words used to describe this time of year by those undergoing the grief process.

Bereaved families are already pulling a heavy emotional load and now we have the added expectations of the past years; people to see, places to go, and things to do. Some old traditions will need to be adapted or eliminated from this year's Holiday agenda. Making that decision requires that you evaluate all of your Holiday concerns in terms of what is truly meaningful to you and your loved ones. You should be ready to change plans and schedules from day to day. Even from hour to hour.

Eliminate The Unnecessary

Decide what traditions are important, what parts of the holidays are pleasant, and which friends and family you want to be with this year. Your home may or may not be the center of celebrations at this time. Let everyone in your immediate circle participate in deciding what should be kept and what should be discarded. Follow through by spreading around the responsibility for getting things done.

It is not necessary to always do, do. Perhaps this year you won't bake for the office potluck, decorate your house with lights, buy a new holiday outfit, or sail through an enormous Christmas card list. Perhaps this year it will be a big step if you just light a single candle in special memory of...That's OK!

Find Ways To Honor Your Loved One

Often, it helps if the activities we dread most can be turned around to create a memorial to those who are not here. For example, if you always put up stockings on Christmas Eve, but fear you cannot do it if you have to leave the stocking that reminds you of that person in the box, ask yourself how you can honor that person. Take the stocking out and put it up. Ask everyone if they will write a note to put inside. Notes can be sealed in an envelope if they are too personal to share, or left open for others to read. On the holiday eve, or morning, they can be read aloud or added to the warmth of a roaring fireplace.

Take the money you would have spent on a gift and make a charitable contribution in your loved one's name. Play his or her favorite music during a holiday meal; plant a tree; create a picture collage of happy moments and make duplicates for family and friends.

Does your family want a Christmas Tree, but you wonder how you'll face sorting through old ornaments? Buy a special decoration for your loved one that will have a place of honor and announce to everyone who that ornament is for. Hang it on the tree where it will be seen by all. One family we know had a tree decorated with lights, ribbons, tinsel, and one special ornament. It was beautiful.

Take Care Of Yourself

Spend time with people who are supportive of your needs and let you talk about your loss. Conversely, plan enough quiet time. Maybe you can just sit and listen to music, soak in a hot bath, or go for a walk. Try setting aside time to write in a journal, your memories, your feelings, your daily activities, or anything that gives you the chance to consider how you are experiencing this season. It's common to feel harried and stressed this time of year anyhow, but if you are grieving you will be even more exhausted and vulnerable to sickness. Try and get enough sleep, and watch what you eat. (The four food groups are not caffeine, tobacco, alcohol and sugar.)

Finally, be kind and gentle in the messages you give to yourself. If tears come, let them. If you are frustrated in your attempts to find someone to share your pain, remember your grief support group. People who have been there, care, and want to help.

Soon the holiday season will pass into a new year. Hopefully, the coping strategies you learn this season will continue to serve you. Sadness, like joy, is usually not limited to one time of the year.

Signs of Holiday Blues / Depression

There are two common signs of holiday blues and/or depression. First, is withdrawing within oneself. This makes one more reserved and less active and tired, thus finding it difficult to make positive decisions. This becomes an escape from being happy and joyful. It allows those around us to excuse our behavior and actions no matter how negative we become. Internal with-drawl can deepen our pain, our isolation, our guilt and our self-blame. The second sign is the opposite. We extend our physical and mental capacities. As the bumper sticker tragically reads; "Shop 'till you drop." You will push yourself with less sleep and rest than at any other time; smiling and acting as we did last year or the year before. "See," you tell the world, "I can go on."

We can and do 'go on.' But the healthiest thing for us to do for ourselves is to accept that we do feel blue, sad and tired. We do feel like crying. But we can let the tears cleanse us. If you need help, share that need, and begin to resolve some of your grief and pain.

Suggested Holiday Resolutions

-Seek out an old forgotten friend.
-Write a love letter to the one you lost.
-Manifest your loyalty by word and deed.
-Listen. Really listen. Deserve confidence.
-Welcome a stranger. Keep a promise.
-Dismiss suspicion and replace it with trust.
-Give a gentle answer to a painful question.
-Forego a grudge and forgive someone who hurt you.
-Apologize if you were wrong. Take arms against malice.
-Laugh a little. Then laugh a little more.
-Take pleasure in the beauty and wonder of the earth

...and "Speak your love" "Speak your love again" "Speak your love still once more"


Agonizing Questions

"Many deaths leave survivors with unfinished business, but few may be said to create more of it than suicide."
Suicide survivors feel ambushed not only by the sudden death of a loved one but also by the crossfire of questions-some of which can be answered and others that cannot.
Why? What could we have done differently? How could we have not known? These are only some of the disturbing questions that tear at the hearts and minds of stunned survivors. In a desperate attempt to understand this incomprehensible event, we search for answers. Yet answers, even if we could find them, cannot replace the loved one we have lost.
Kay Reified Jamison describes the agonizing journey survivors must travel: "Death by suicide is not a gentle deathbed gathering. It rips apart lives and beliefs, and it sets its survivors on a prolonged and devastating journey. The core of this journey has been described as an agonizing questioning, a tendency to ask repeatedly why the suicide occurred and what its meaning should be for those who are left."

Why Do Some People Choose Suicide ?
The most haunting question that survivors must face is "Why?" Why would a loved one choose to end his or her life prematurely?
Albert Camas, the French philosopher and novelist, wrote in The Myth Of Sisyphus : "There is but one truly serious philosophical problem, and that is suicide judging whether life is or is not worth living, amounts to answering the fundamental question of philosophy."
The vast array of these "why" questions are what initially torment survivors on the first necessary leg of their questioning journey. While they may not address the deeper "whys" of what may have caused the suicide, the search for answers clears the way for survivors to move on and wrestle with the deeper questions of the heart.
Albert has describes his quest as a survivor to find answers to his father's suicide: "Those of us left behind often find ourselves searching for a precise event that caused the suicide. We think that the act will cease to be incomprehensible if we can identify something as the cause. But we must make a distinction between causes and triggers."

The Centers for Disease Control and Prevention agrees. Its guidelines for the media when covering suicide stories stresses:
"Suicide is never the result of a single factor or event, but rather results from a complex interaction of many factors and usually involves a history of psycho social problems." What is often identified as the final triggering event is rarely if ever the real cause of the suicide.
It's helpful to understand the distinction between causes, triggers, and predispositions if we are to avoid simplistic explanations for why some people choose to end their own life.
Triggers are those normal and sometimes tragic difficulties that everyone faces regularly. All of us have our fair share of "thorns and thistles" and trouble to deal with. And it's encouraging to remember that in spite of the magnitude of the struggles, most people find a way to face those disappointments and even disasters without ever resorting to suicide. While a death, divorce, financial reversal, illness, job loss, or ending of a relationship nay be blamed for pushing someone over the edge, these are precipitating events, not final causes.
"Difficulties in life merely precipitate a suicide," wrote American artist Ralph Barton in his own suicide note, "but they do not cause it."
Causes are like internal operating system, the software that directs the choices an individual makes in response to a triggering event, Causes are not singular but multifaceted and complex. They are interwoven into the core fabric of what a person has come to learn about life, himself, and God. And they govern his capacity to choose. The bottom line is that whatever makes him tick on the inside eventually implodes from the outside in.
As important as they are, causes and triggers don't tell the whole story. There's more to consider. Predispositions are the temperament and genetic vulnerabilities that make some individuals susceptible to suicidal thought and behavior. They are the "hardware" that the "software" runs on.
Studies in Europe, Asia, Australia, and the US all confirm that 90 to 95 percent of suicides are associated with some form of diagnosable mental illness, including, but not limited to depression, manic depression, borderline and antisocial personality disorders, and schizophrenia. Of those, major depression afflicts 50 per cent, making the suicide rate for people tormented with depression eight times higher that the general population.
Those struggling with these inherited predispositions often resort to drugs or alcohol to self-manage their inner turmoil. Instead of helping them, their vulnerability to self-destruction increases exponentially.
While this is alarming, it's encouraging that most people who struggle with such disorders don't succumb to their suicidal urges.
The intricate interplay between triggers, causes, and predispositions is so complex that rarely are the conclusions definitive enough to provide the understanding that survivors are looking for.


SUICIDE : Holidays' Darkest Myth - Edited from The LA Times

It was Christmas Eve when George Bailey stared into the black depths of the river beneath the bridge in Bedford Falls. He was convinced that the world would be better off without him. That scene from the 1946 movie classic "It's a Wonderful Life" could well have given birth to the media myth that Christmas is a trigger for increased suicides and episodes of depression.
It is a baseless notion, according to a body of published studies by statisticians who have examined hundreds of thousands of suicides in the United States and around the world. The number of suicides goes down, not up, over the holiday season, by as much as 40%.

During the season of good cheer, there are certainly those whose blue mood stands in stark contrast to the season's bright lights and festivities. But pointing to the Christmas season as a cause of increased depression and risk for suicide is just wrong, says Dan Romer, director of the Annenberg Adolescent Risk Communication Institute at the University of Pennsylvania.
"Holiday blues?" asks Dr. Eric Caine, co-director of the center for the study and prevention of suicide at the University of Rochester Medical Center in New York. "I'm not sure. I just know I get a lot fewer admissions, to the psychiatric ward over the holidays."

In one of the most thorough examinations of what researchers call acts of deliberate self-harm, which can be an indication of depression, Helen Bergen, research scientist at the University of Oxford, found that Christmas, for most people, is protective.

Bergen and colleagues reached this conclusion after examining emergency room admission records of 19,346 people in England and looking at daily rates of self-induced injury from 1976 to 2006.

Drug or alcohol overdoses, self-poisoning with gas or other harmful substances and self-inflicted injuries– with or without the deliberate intention to die – all decreased from average levels during the week of Dec. 19-26, Bergen and colleagues found, and these lowered levels held through New Year's Day.

The decrease in rates of self-inflicted damage before, on and immediately after Christmas and into the New Year was found regardless of age, family connections or social isolation, the researchers reported in the September issue of the journal Social Science & Medicine.

Even people with family relationship problems were less inclined to attempt to hurt themselves during the holidays. "These findings are contrary to the popular view that Christmas is a time of stress and arguments," Bergen says. Perhaps, she says, problems within the nuclear family ease up instead of intensify when the extended family is around.

Another possible reason why depression and suicide rates fall this time of year is that the season, more than other times, is one of giving. "People tend to reach out over the holidays," says Dr. Douglas Jacobs, a psychiatrist at Harvard Medical School. Elderly people in nursing homes might suddenly get visitors. People who haven't heard from friends all year might get a card or a telephone call.

It's only in the last year that the majority of news stories reflected the fact versus the myth about seasonal suicide rates, says Romer, who since 2000 has been tracking trends in media interpretations of the link between holidays and suicide. In a national search of news stories linking the holidays with suicide, he says, 9% of news organizations supported the myth in 2006, compared with 57% in 2005 and 77% in 1999.

This is not to say that the holidays are easy for everyone. "Some people have unreasonable expectations – the holidays have to be happy," says Dr. Ian Cook, director of the UCLA depression research program. If in-laws are sniping at you about your home, your food and your lifestyle; your 2-year-old has already broken his new toys and is wailing; and your sister's teenage daughter is sulking in the family room, happiness can be a tall order.

Others are reminded of losses at holiday time. Some churches have started offering a special Worship Service –more somber and reflective than joyful –on Dec. 21, often the darkest day of the year, or on Christmas Eve.

"The holidays put on us an expectation for a certain set of feelings," says Father Larry Rice, pastor at the St. Thomas More Newman Center at Ohio State University, which will be celebrating a "Blue Christmas" Roman Catholic Mass on Christmas Eve. "Everyone around them seems joyful, and they're not feeling that."

Ryan Warne-McGraw, associate pastor at the Good Shepherd Lutheran Church in Irvine will hold the church's second Blue Christmas service Thursday. Last year's service was a hit, he said, an acknowledgment that traditional services can be hard on widows, widowers, divorcees or people who have lost jobs or loved ones. "Not everyone wants to come and sing Christmas carols," he says.

It's that kind of cultural reaction – an extra dose of caring – that probably adds to the psychological protection of a season that seems to insist on happiness. No matter how bad it may seem, holiday rituals add up to more good than bad, buffering adults and children against depression and anxiety.

Barbara Fiese, chairwoman of psychology at Syracuse University, reviewed 32 studies done over 50 years and concluded that holiday family rituals may be annoying, but they're good for us. People with strong family routines and rituals at holiday time reported more marital satisfaction, better academic achievement among children and better overall health among family members, she found. Even in families in which there has been a divorce, the continuation of family rituals improves the children's ability to adapt and increases their stability.

"Each family defines its own rituals," she says. "It can be things as simple as unpacking a particular ornament or menorah, or cooking a dish that's been passed down for generations. It provides an emotional connection, a symbolic bonding."

Certainly, many people feel alone during the holidays. But, Caine of the University of Rochester asks, "If you banned all holidays, do you think people would feel happier or sadder? If they were really bad for us, do you think they'd have been around for so long?"


Study Refutes The Link Between Suicide Risk & Antidepressants

New findings challenge a 2004 advisory by the U.S. Food and Drug Administration (FDA), which warned that suicidal behavior may emerge after treatment with the newer antidepressant drugs has begun.

"Our findings show that, fortunately, suicide attempts and death by suicide are rare following the initiation of antidepressants," says Greg Simon, MD, MPH, a Group Health psychiatrist and the lead researcher on the study. "The period right after people start taking antidepressant medication is not a period of increased risk. In fact, risk after starting medication is lower than before."

This study is the first published analysis to compare the risk of suicide attempts before treatment to the risks following treatment. It is based on computerized medical and pharmacy records for more than 65,000 patients who filled prescriptions for antidepressants from 1992 to 2007. Deaths by suicide were determined from death certificates and suicide attempts were identified from hospital discharge data.

Group Health researchers found that the number of suicide attempts fell by 60 percent in adults during the month after antidepressant treatment began, and declined further in the following five months. Among the 65,103 patients taking antidepressants, there were 31 completed suicides in the six months following the antidepressant prescription. That rate was not higher in the first month after the prescription was given than in subsequent months. The study also found that newer antidepressants were associated with a faster decline in rates of suicidal behavior than older drugs.

Adolescents in the study had more suicide attempts than adults. The researchers found that the rate for the first six months of antidepressant treatment was 314 attempts per 100,000 in teens and 78 attempts per 100,000 in adults. As with adults, the rate was highest in the month before treatment and declined by about 60 percent after treatment began.

Given recent public concern over a possible link between suicide and antidepressants, Simon says he fears people may mistakenly believe that suicidal behavior is common after taking antidepressant medications. That misperception could lead to fewer people with depression being treated with medications proven to be effective in battling depression, he adds.

"There may be subgroups of people who become more agitated or suicidal after taking these drugs, and those people should seek help from a doctor or therapist right away if that happens," says Simon. "But our study showed that on average, the risk of suicide actually goes down after people start taking the antidepressant."

Simon agrees with the FDA's recommendations that doctors carefully monitor people taking antidepressants. "Keeping a close watch on patients after they begin taking these drugs is a good idea — although not because these medicines are especially risky or dangerous," he says. "Patients need to be monitored to ensure they're getting the right medication in the amount that can help them feel better."

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