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January 2008

GRIEVING NOTES

By Linda Vigil

" FAITH AND CHANGE "

In reflection of the past twenty-four years, I have experienced a gift that I felt was deep within me, but had taken time to surface. The gift is faith. I am not speaking of religions, or churches, but faith, meaning "anything believed, complete trust, openness, non-judgmental, confidence or reliance, unquestioning belief that does not require proof or evidence."

In reflection, I also remember after the death of our daughter, Mia, how I would go to the ocean in San Diego, questioning my faith, the meaning of life, and questioning my future as a mother and wife, and even as someone's friend. The ocean seemed to beckon to me, I would spend hours watching the tide ebb back and forth on the shore as I even questioned human existence. I was haunted by the water and it's constant change and movement -for I feel it speaks to our human experiences.

The words spoken to me through the rhythm of the ocean reached my soul, giving me hope and understanding.

No matter what tragedies and unhappiness happens in your life, the waters bring you back to the meaning and the rhythm of life, The ocean has time and time again, given me the feeling of strength, purification and lightness, and the meaning being that we can choose life, and the rhythm being that life goes on in spite of change.

I have come to believe that there are people in this world who need help desperately. Mia was a perfect example of someone who could not find it within herself to reach out and ask.

I have come to understand that the laws of Nature treat us all alike. We are vulnerable to accidents, tragedies, illness, no matter how good we are, or if we believe in God or do not believe in God.

We are free to choose how we live, and what we do with our tragedies, and how we handle our illness, and yes, even our times of happiness.

For me, my belief in God, and my deep Faith which has not only survived, but has become stronger -so that I could continue to grow and open my vulnerability to share the "Mia Story." Her beautiful life, her tragic death, her successes, her flaws, our roles as her parents and our joy as having her as our gift for eighteen beautiful years.

My Faith and my belief in my God, twenty-four years after Mia's completed suicide, is that you can love completely without understanding. I will never understand completely why Mia chose to stop her life by suicide, but I understand completely that we will always love her.

I no longer expect the world to make me warm and safe -but in our Sharing and Healing maybe we can make the world a little warmer and safer for each other.


LET'S TALK ABOUT SUICIDE
Edited from - Canadian Globe and Mail Update - October 2007

We campaign for a solution to prevent the deaths of Canadians waiting for organ transplants. We wear ribbons and advocate for safe sex to protect our loved ones from HIV/AIDS infection. We break down barriers and speak openly about colonoscopies and prostate exams as means for early detection of cancers.

Yet, when it comes to the more than 4,000 Canadians who die from suicide each year, we are curiously silent. Scan the obituaries and you'll find these Canadians. Most are young and male. And their cause of death remains unmentioned, thinly veiled behind the word 'suddenly.' But this killer does have a name, and its onset is rarely sudden. It's called mental illness: Most people who kill themselves are suffering from a diagnosable mental illness, with depression as the most common of these.

Depression is now the fourth leading cause of disability and premature death in the world. The World Health Organization predicts that, by 2020, depression will move up the ranks and become the second leading cause of disability in the world, preceded only by heart disease. WHO tells us that, worldwide, someone commits suicide every 40 seconds. In Canada, suicide is one of the leading causes of death for both men and women from adolescence to middle age. Since Jan. 1, 2000, we have lost nearly 31,000 Canadians to suicide. And that number is the reported number; countless suicides continue to go unreported.

So, in the midst of a clear health crisis, why are we still so reluctant to speak about mental illness? The dark truth is, we still believe many of the myths around suicide. The most pervasive and insidious of these are that suicide is volitional, that it is morally wrong, and that the suicidal are weak and selfish. With these kinds of attitudes, it's not surprising that suicidal people isolate themselves or that families whose loved ones died by suicide choose to stay silent on the cause of death.

Suicide is not chosen -it happens when pain exceeds the resources for coping with pain. To help prevent suicide, we need to lessen the mental and physical pain caused by the illness itself. We also need to lessen the emotional pain that comes from facing stigma. Only in doing so can we encourage sufferers to freely seek treatment. Finally, we need to ensure that our communities have the health resources capable of handling patients in a mental health crisis and community supports readily available to those who need them.

This kind of approach has brought tangible progress in other countries and the Canadian Mental Health Commission, chaired by Michael Kirby, will develop strategies to help increase Canadians' understanding of mental health and mental illness and thus reduce the stigma of suicide. Success can be attributed to, dedicated senior government leadership willing to champion the project, adequate and sustained funding over the long haul, and taking the long view, with continued activity over time.

WELL - DEFINED GOALS -AWARENESS IS NOT ENOUGH
Attitudinal and behaviour changes must result.
Clear understanding of the intended audience.
Approaching the problem from multiple directions.
Education, policy and procedural changes, new practices and improved standards.
Evaluating right from the outset, and using the results to correct messages.
Change activities on a continuing basis, as well as to measure outcomes.

Deaths from suicide are preventable. Depression is a highly treatable disorder. 80% of those who seek treatment for depression respond well to treatment. Yet, 90 % of those who have depression never actually seek treatment. Why is that? A large part of the answer lies in cultural and societal stigma, which often expresses itself through silence.

- LET'S TALK ABOUT MENTAL ILLNESS.

- LET'S TALK ABOUT DEPRESSION.

- LET'S TALK ABOUT SUICIDE.


"TWO HORSES" - A Devotional

From a distance, each horse looks like any other horse. But if you stop your car, or are walking by, you will notice something quite amazing. Looking into the eyes of one horse will disclose that he is blind. His owner has chosen not to have him put down, but has made a good home for him.

This alone is amazing.

If you stand nearby and listen, you will hear the sound of a bell. Looking around for the source of the sound, you will see that it comes from the smaller horse in the field. Attached to the horse's halter is a small bell. It lets the blind friend know where the other horse is, so he can follow.

As you stand and watch these two horses, you'll see that the horse with the bell is always checking on the blind horse, and that the blind horse will listen for the bell and then slowly walk to where the other horse is, trusting that he will not be led astray.

When the horse with the bell returns to the shelter of the barn each evening it stops occasionally and looks back, making sure that the blind friend isn't too far behind to hear the bell.

Like the owners of these two horses, God does not throw us away just because we are not perfect or because we have problems or challenges.

He watches over us and even brings others into our lives to help us when we are in need.

Sometimes we are the blind horse being guided by the little ringing bell of those who are in our lives.
Other times we are the guide horse, helping others to find their way.

Good friends are like that... you may not always see them, but you know they are always there.
Please listen for my bell and I'll listen for yours.

And remember...be kinder than necessary -everyone you meet is fighting some kind of battle.

- Live Simply,
- Love Generously,
- Care Deeply,
- Speak Kindly,
- And Leave The Rest Up To God.


"GRIEF AFTER SUICIDE"

Coming to terms with the death of a loved one is one of life's most challenging journeys. When the death is from suicide, family members and friends can experience an even more complex kind of grief. While trying to cope with the pain of their sudden loss, they are overwhelmed by feelings of blame, anger and incomprehension. Adding to their burden is the stigma that still surrounds suicide. Survivors of suicide and their friends can help each other and themselves by gaining an understanding of grief after suicide. For survivors, it helps to know that the intensity of their feelings is normal. Friends can learn how to support the bereaved.

A DIFFERENT GRIEF
Survivors of suicide -the family and friends of a person who completes suicide, feel the emotions that death always brings. Adding to their suffering is the shock of a sudden, often unexpected death. As well, they may feel isolated and judged by society, friends and colleagues. Some people compare the emotional stress to being trapped on an endless roller-coaster. Survivors may feel, guilt, anger, blame, shame, confusion, relief, despair, betrayal, abandonment and disconnected from their loved one because he or she chose to die. They may be consumed by a need to find the meaning and reasons for the suicide. It can become an exaggerated sense of responsibility for the death the suicide was malicious, or a way for the deceased to get back at them.

STIGMA AFFECTS MOURNING
Suicide is a difficult topic for many people. Cultural and religious taboos can lead to judgmental or condemning attitudes. Some people prefer to avoid even discussing suicide and their lack of knowledge about it makes them fearful. Attitudes like these can isolate and further stress survivors. Stigma leads survivors to feel abandoned by their social network. They describe being avoided by friends or acquaintances. The may feel judged and they will meet people that will behave as if the death had not occurred. Some survivors perceive stigma that is not really there. They may anticipate difficult questions and disapproval, and they may withdraw in order to protect themselves. Whether it is real or perceived, stigma can affect a survivor's journey to acceptance.

WHAT SURVIVORS SHOULD KNOW
First, know that you are not alone. Approximately 1 out of 4 people know someone who died by suicide. It can also help to know that suicide was the decision of the person who died. It is estimated that the majority of suicides are the result of untreated depression or other mental illness.

SURVIVORS ARE AT RISK
Survivors of suicide are at high risk of completing suicide themselves. The experience suddenly makes the idea of suicide very real, and it is not uncommon for survivors to experience suicidal thoughts. Another factor is that suicide-related illnesses like depression run in families. Because of this increased risk for suicide, survivors should not be isolated, but rather supported and encouraged to talk about all their feelings -even the most difficult ones.

SURVIVOR COPING STRATEGIES
No two people ever experience grief in the same way, or with the same intensity, but there are strategies that can help you cope with your loss. Acknowledge that the death is a suicide. Recognize your feelings and loss. Talk openly with your family so that everyone's grief is acknowledged and can be expressed. Reach out to your friends and guide them if they don't know what to say or do. Find support groups where you can share your stories, memories and methods of coping. Be aware that anniversaries (e.g. birthdays) can be especially difficult and consider whether to continue old traditions or begin new ones. Develop rituals to honor your loved one's life.

HOW CAN I HELP MY FRIEND?
Showing a willingness to listen is probably the most important thing you can do for a friend who is a survivor of suicide. It may be distressing at first, but you're not expected to provide answers. Instead, you can be a comforting, safe place for someone who desperately needs to talk.

WHAT YOU CAN DO?
Listen with non-judgmental compassion. Understand that your friend will need time to deal with their loss. Avoid clichés. Talk about the person who has died. Offer practical assistance such as shopping, cooking, driving. Find and offer information on resources, support groups, etc. Be aware of difficult times, like anniversaries and holidays.


SADNESS, ANGER, HOPE, -SIX YEARS AFTER 9/11
Edited from an article in San Diego Union-Tribune

For this, the sixth anniversary of the deadliest terrorist attack on U.S. soil, the San Diego Union-Tribune wanted to find out what comes to mind when people think of Sept. 11, 2001. So we asked readers to describe, in one sentence, "what 9/11 means to you." Some responded with an analysis of the geopolitical implications of the events of Sept. 11, 2001.

Others offered intensely personal thoughts about how they've been changed by what they witnessed that morning six years ago. Those memories, a Coronado woman wrote, should serve "as a reminder to those who wallow in self pity over sitting in traffic too long, a "bad hair' day, the price of gasoline, etc. May we never forget the precious gift of life."

We received more responses than we could possibly print. Below are a few of them:

"It was the day Americans put aside their differences and wept together." - Lillian Conat, 64, Vista, retired.

"9/11 is my generation's JFK assassination." - Matthew Luckham, 25, Del Mar, financial advisor.

"9/11 means to me the same as Pearl Harbor does." - Patricia Whithead, 74 Santee, retired nurse.

"It means one breath is taken away with the pain for those who died that fateful day and for those who loved them, and the next breath is filled with gratitude for all I have and for being in this wonderful country." - Janel Meehan, 32, Serra Mesa, middle-school teacher.

"Sept.11 reminds me that we should cherish life each day to it's fullest and love God with all our hearts and just love our family and our fellow man." - Timothy Leonard, Old Town, student.

"Since 9/11 I realize how very beautiful our world is, how very ugly our world can be, and how truly vulnerable the human race is." - Cindy Feinstein, 50, Coronado, account manager.

"For me, 9/11 means that there is no end to the bravery people who live in freedom will display to save lives, and no end to the cruelty others will display when they choose to live in hatred and intolerance." - James Hennessy, 58, Carmel Valley, business executive and writer.

"To me, 9/11 was the proof that we ignore the maxim 'Eternal vigilance is the price of freedom' only at the peril of our freedom, our property, and our lives and the lives of our fellow citizens." - Mark Hartman, 51, El Cajon, manager of a sign company.

"9/11 was a terrible tragedy and let us not continue the tragedy with one more death of an American soldier." - Linda Juhasz, 55, Tierrasanta, homemaker.

"9/11 means the loss of innocence and the beginning of incredible patriotism and faith." - Patty Millsap, 56, Spring Valley, florist.

"9/11 is a wake-up call for prayer and peace for all nations."- Ines Santos, 70, retired nurse, Clairemont.

"Peace is a fragile thing and must be protected with love, understanding, and, above all, strength." - Glenda Lamb, 73, Rancho Bernardo, retired technical writer.

"Sept. 11 acted as catalyst for the United States to once again act as a nation that does something positive rather than as a nation full of cynics and critics," - Kevin McCarthy, 55, Normal Heights, retired businessman.

"It means to our family that we light three candles in remembrance of those lives lost in New York, Washington, and Pennsylvania." - Mindy White, 45, Clairemont, medical transcriptionist. (Al & Linda Vigil's daughter).

"The morning of September 11, 2001 was full of terror and tremendous sadness yet the afternoon brought welcomed peace and great joy as our grandson was born at Kaiser Permanente Hospital in San Diego." - Gwen Archambeault, 65, San Carlos, homemaker.


RATES of SUICIDE and DEPRESSION RANKED by STATES
- Edited From USA TODAY -

A new study, released by Mental Health America, ranks the fifty states & the District Of Columbia when it comes to depression and suicide. The study uses federal data to rank all in both categories.

The report concludes that a number of factors contribute to higher suicide and depression rates in some states, including lack of access to mental health care, a smaller number of mental health professionals and the number of people without health insurance. The higher the percentage of residents in a state who say they can't afford health care, the greater the prevalence of serious depression and the higher the suicide rate in that state, suggests the report.

The report doesn't prove that lack of care causes depression or suicide, says senior author Tami Mark of Thomson Healthcare. "But it suggests we should be monitoring mental health care and comparing outcomes," she says. Mark used federal data on mental health and state databases to develop a "depression index."

Major depression strikes 17% of Americans, and about 30,000 a year commit suicide, figures show. States with more affluent residents tend to have better mental health ratings, but the tie between barriers to treatment and increases in depression can't be accounted for by different average incomes in the states, says David Shern of Mental Health America, an advocacy and education group that commissioned the survey funded by pharmaceutical company Wyeth, which had no influence on the design or outcome, Shern says.

The results underscore the importance of health insurance as a campaign issue and of a mental health parity bill before Congress, he says. "There are consequences of no mental health treatment -it can cost lives."

The report may be oversimplified "because there are so many differences between states, it's hard to capture them all," says health policy researcher Ronald Kessler of Harvard Medical School. For example, many rural, Western states have high suicide rates. "Isolation raises the risk of suicide, and so do households having guns, which is the case in these Western states," says Paula Clayton, medical director of the American Foundation for Suicide Prevention.

John Holahan, director of Health Policy Center at the Urban Institute says of the report, "it's pretty interesting and important because it suggests that having insurance and improving access to care has an impact on mental health and suicide."

States ranked by the prevalence and seriousness of depression among residents, from the least at number 1 (one) to 51 (fifty-one) at the bottom are:

1. South Dakota, 2. Hawaii, 3. New Jersey, 4. Iowa, 5. Maryland, 6. Minnesota, 7. Louisiana, 8. Illinois, 9. North Dakota, 10. Texas, 11. Georgia, 12. Vermont, 13. Nebraska, 14. Florida, 15. California, 16. Massachusetts, 17. Pennsylvania, 18. Virginia, 19. New York, 20. New Hampshire, 21. Alaska 22. Michigan, 23. District of Columbia, 24. Delaware, 25. Arizona, 26. Alabama, 27. North Carolina, 28. South Carolina, 29. Kansas, 30. Wisconsin, 31. Tennessee, 32. Montana, 33. Mississippi, 34. Colorado, 35. Washington, 36. New Mexico, 37. Oregon, 38. Connecticut, 39. Indiana, 40. Arkansas, 41. Maine, 42. Wyoming, 43. Ohio, 44. Missouri, 45. Idaho, 46. Oklahoma, 47. Nevada, 48. Rhode Island, 49. Kentucky, 50. West Virginia, 51. Utah


"In this life we cannot all do great things;

we can only do small things with great love."

- Mother Teresa -


PREVENTING SUICIDE AMONG THE ELDERLY
Edited from - The New York Times- November, 2007

Suicide is more common among older Americans than any other age group. The statistics are daunting. While people 65 and older account for 12 percent of the population, they represent 16 percent to 25 percent of the suicides. Four out of five suicides in older adults are men. And among white men over 85, the suicide rate - 50 per 100,000 men - is six times that of the general population.

Yet, says Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, "If you consider only major depression as the antecedent of elder suicide, you'll miss 20 to 40 percent of cases in which there is no sign of mental illness." Kennedy, who is also affiliated with Albert Einstein College of Medicine, recently directed a symposium here on preventing suicide in older adults, designed to alert both mental health and primary care practitioners to the often subtle signs that an older person may try to end it all.

THE WARNING SIGNS - In interviews, he and other symposium presenters noted that detecting suicidal impulses in older people often depended on the ability of family members and friends to recognize warning signs and act on them. According to Gregory Brown, a suicide specialist at the University of Pennsylvania, in studies of what preceded elder suicides, "suicide ideation" - the wish to die or thoughts of killing themselves -appears not to have been taken seriously. In 75 percent of cases, the suicide victims "had told family members or acquaintances of their intention to kill themselves," Brown said.

Kennedy put it this way: "This is not simply a doctor's problem. We need to think of elder suicide more as a social problem and look out for individuals at risk."

Primary care practitioners are also crucial to suicide prevention among the elderly because older people, and especially older men, are unlikely to seek out and accept mental health services but are often seen by family doctors and nurses within days or weeks of a suicide. Among suicide victims 55 and older, 58 percent visited a general physician in the month before the suicide. In fact, 20 percent see a general physician on the same day and 40 percent within one week of the suicide.

While major depression is the main precipitant of suicide at all ages, social isolation is an important risk factor for suicide among the elderly. And older men, more so than older women, often become socially isolated. Widowers are especially at risk because older men in the current generation tend to depend on their wives to maintain social contacts.

When wives die, their husbands' social interactions often cease. "Older males who live alone are an endangered species," Kennedy said, "-particularly in states like Wyoming, Montana and Nevada, where the social distance is great and firearms are a part of the culture."

Many men are poorly prepared for retirement, and don't know how to fill in the hours and maintain a sense of usefulness when they stop working. "They often sit around watching TV," said Martha Bruce, a professor of sociology and psychiatry at the Weill Medical College of Cornell University in White Plains, New York. And Kennedy said, "After retirement a lot of older men start drinking heavily, a sign of increased aggression turned inward." He called heavy drinking or binge drinking a risk factor for suicide among the elderly.

A particularly vulnerable time may be after the diagnosis of a life-threatening disease like cancer. Older men who were recently discharged from the hospital are also at high risk, Kennedy said. They need to be periodically screened for depressed mood, loss of interest in life and thoughts of killing themselves. Serious personal neglect is another warning sign; people can commit a kind of passive suicide by failing to eat, letting themselves become dangerously sedentary or not taking needed medication.

DEALING WITH DEPRESSION - Contrary to what many people think, depression is not a normal part of growing older. Nor is it harder to treat in older people. But it is often harder to recognize and harder to get patients to accept and continue with treatment.

"Most people think sadness is a hallmark of depression," Bruce said. "But more often in older people it's anhedonia - they're not enjoying life. They're irritable and cranky." She added, "Many older people despair over the quality of their lives at the end of life. If they have a functional disability or serious medical illness, it may make it harder to notice depression in older people."

Family members, friends and medical personnel must take it seriously when an older person says "life is not worth living," "I don't see any point in living," "I'd be better off dead" or "My family would be better off if I died," the experts emphasized.

"Listen carefully, empathize and help the person get evaluated for treatment or into treatment," Brown urged. He warned that "depressed older adults tend to have fewer symptoms" than younger adults who are depressed.

The ideal approach, of course, is to prevent depression in the first place. Brown recommended that older adults structure their days by maintaining a regular cycle and planning activities that "give them pleasure, purpose and a reason for living."

He suggested "social activities of any type -joining a book club or bowling league, going to a senior center or gym, taking courses at a local college, hanging out at the coffee shop." Bruce suggests taking up a new interest like painting or needlework or volunteering at a place of worship, school or museum. Brown notes that any activity the person is capable of doing can help to ward off depression and suicidal thinking. And he urges older people to talk to others about their problems.

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