– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. It’s an emotional subject: coping with the loss of a loved one from suicide. So, what steps can you take to begin the healing process? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Kelly Monk. She is a clinical research supervisor and co-leader of the Survivors of Suicide Group at UPMC Western Psychiatric Hospital. Thank you so much for joining us.
– Thanks for having me.
– This really is an emotional subject. The loss of a loved one can be difficult, no matter what, particularly in a circumstance like this. What does the broader picture look like when it comes to steps to begin healing?
– Yeah, it’s such a complex issue. Suicide bereavement is bereavement-plus because there’s the stigma associated to this type of loss. There’s guilt, there’s blaming, there’s shame. So, it’s a very complex process. And, so, yeah, to begin the healing, I think it’s just minute by minute, you have to kind of see your way through it. But it’s minute by minute, breath by breath, hour by hour, really, to begin the healing process and whatever it takes.
– So, as you already touched upon, great stigma can be attached to this, and suicide can be a taboo subject. What do you want to say to people about the importance that they do talk about their feelings?
– Sure. So, I think that developing the narrative of the loved one’s death, I think that that’s one of the first steps in the process of preparing to share with others what that story might be, so they can kind of explain. Because people have questions about it. And, so, if you are a bit more prepared, and have developed this narrative for yourself, it also helps in the grief journey, too. Because grief is not a linear process. It can be all over the place, kind of like bendy, like cooked spaghetti is a way we describe it. And, you have to sometimes go back in the process, too. So, a few steps forward, a few steps back. And, so, by developing this narrative, it helps with the journey moving forward.
– And what would that narrative perhaps look like or sound like? Can you give me an example? What sort of things would you encourage people to look at and to put into that narrative?
– I think that it’s whatever you feel comfortable with it, but it’s kind of like their life and their legacy. Because we – people tend to reexamine everything about their relationship with this person when someone dies by suicide. They kind of overthink what their role in their suicide played, and so by processing it, by thinking about the story, and what you are able to share with people, what you’re willing to share with people, and what you’re not willing to share with people, too. Because I think it’s really good to be able to practice saying “I’m not comfortable talking about it, I’m not comfortable sharing that information,” or something like that. But, whatever they’re comfortable sharing is what should be shared. Every person’s experience is so unique, so listen to yourself. Listen to what you feel will work and be helpful to you. Letting people know, too, what will help you, and what won’t help you. At this point, what do you have to lose? Because the worst thing has happened to you. And, so, you just have to be your own advocate because people don’t know unless you tell them what it is that you need in this moment. So, I would just say stand up for yourself.
– And when it comes to telling people what you need, is that, can it be food, is it privacy, is it someone to talk to, no one to talk to, leave me alone? What are some of the things that you’re telling someone when you say, “Tell people what you need”?
– It’s different for everybody. So, just think about general bereavement. You know, people want to make you meals, and bring things over, and those kinds of things. And sometimes you’re just not up to visiting. So, there’s been things like, tell them, “Be specific,” I would say would be the first thing. Is like, so if they’re bringing by a meal, you’re like, “You know what, thank you so much. That’s great. I’m going to leave a cooler outside, and you can just leave it there.” You know, that’s just a specific example of one thing that people have said has worked for them because then, in that moment, if you’re not up to talking to somebody, for them spending time, you’ve built this in. Or, just say, like, for children, it’s important to keep them as much on routine in those early days as possible. You know, there are certainly circumstances that could limit them, but like, as soon as they can get back to school, and those kinds of things, can be helpful. But say the kids need a ride home from school, and you just don’t feel up to it. Reach out to somebody and say, “Hey.” Because people do want to help, and they just don’t know what that is. And, so, just be specific, and let them know what that could be.
– Someone from the outside looking in and wanting to support this person who was left behind, what is an appropriate way to ask about it? Is there something you should say? Is there something you should never say?
– Yeah. So, I think that there are lines. You know, the typical lines, like, “God never gives you anything more than you can handle.” That’s an inappropriate thing to say to someone. I think that there’s these terms about “committed suicide,” I think that really is hurtful to people because it sounds like an illegal act or something like that. And, so, I think that those are the things you probably shouldn’t say. You can say “died by suicide,” is a term that is a little bit more acceptable. I think that, also, people in their own discomfort, when they really might want to reach out to someone, but they are hesitant sometimes – in all types of bereavement, but especially in suicide bereavement. But by not acknowledging it, it can be just as hurtful as saying something inappropriate as well. So, to be honest with you, the power of a person’s presence, just showing up for the person. And, you really don’t have to say anything at all, really. But just being there for the person is really the most helpful thing.
– And, you already mentioned, it’s squiggly like spaghetti. So, people shouldn’t hold themselves to a timetable of, “So much time has passed, I should be better, and through this.”
– In the early days, it’s acute grief. Like, every domain of your life is impacted by this loss. And, so, your worldview is disrupted. It’s shattered, basically. You know, your core beliefs and everything you know, it’s like a tsunami of emotion is just flowing at you. That’s why you have to take it breath by breath, minute by minute, day by day, in the early days. And, then, as time goes by, you begin to integrate your grief. You never get over grief. You just integrate it into your life, and, hopefully, build a lasting bond in another way with your loved one, through the work that you’ve done developing this narrative and reconciling things for yourself.
– And, so, then, tell me a little bit about the group that you co-lead, and really what the approach is, and sort of who takes part, and how you see progress and help with those people?
– This is a UPMC STAR-Center Survivors of Suicide support group, SOS for short. And, it is an eight-week closed group, meaning that we all start the group together, and we all end the group together in those eight weeks. People can’t drop in just to check it out, or be there for a session or two. It’s kind of eight weeks with the whole group together. And, it’s for 18-year-old individuals and older, and they can be at any stage of their loss. We had one woman who joined the group 50 years after her father died. She had never had any treatment for it, came in 50 years. It’s never too late. It can be too early because in those acute phases of grief, or those early stages, like, I would say maybe the first three months, it can be too soon. So, the first few weeks of the group is developing this story and sharing the story of our loved one. Not only about how they died, but how they lived. We really want to know about their legacy. And, so, you begin to share that with the group, and the group becomes very cohesive. And, then, the last four weeks is kind of like restoration-focused, more focusing on their grief journey.
– How does the restoration work then take place? Like, are there specific exercises you do? What are some of the concrete things that take part in that second half?
– It’s really based on people’s feedback and input. Like, they will pose questions to one another. We’ll talk about the effects of grief. So, we’re talking about the loved one in the first four weeks. The second four weeks, we’re talking about what their grief journey has looked like, what symptoms have they had. Because it affects people physically, emotionally, spiritually. So, it’s good to hear what other people are experiencing because of this isolation factor that we talked about. You know, you think that you’re the only one that could be feeling this way. So, when you hear about people sharing their stories, how they’ve been feeling, what they’ve done to cope, you know, it helps them in the process and realize that they’re not alone, that they’re not the only ones that are feeling this way. It’s really a beautiful thing to witness. People make great progress in the group. You know, people start the group with, very emotional, of course, and apprehensive, especially that first week. But, as time goes by, there’s tears and laughter, and it really, the people who have, whose loss was some time ago, really can take on an important role in the group by kind of like sharing the stories, asking questions, talking about their experiences. It really can give hope to the people who are earlier in their grief journey moving forward. And I think it’s meaningful to the people who have been out a little further.
– And you just mentioned physical health can also be a big part of this grieving process. And, talk about the importance of self-care for someone when they’re going through something like this.
– Depending on what phase they are in their grief journey, I mean, in the early days, your appetite can be disrupted. You can have sleeping problems. You can have physical symptoms that could feel like a heart attack. And, of course, now, people tend to be hypervigilant about it. And, so, it could be a panic attack. People who have had physical problems and medical problems beforehand tend to have an exacerbation in any of those problems they were having in their early phases of their grief. And, people who didn’t have physical problems before now may experience physical problems.
– It’s just the magnitude of the emotions that would come along with this that lots of folks would seek professional help. But if someone hasn’t: A, when do you know it’s time, and B, can you take care of yourself on your own without seeking professional help?
– I think that having some guidance in this journey can really be helpful. And I think it’s very important to be in a suicide-specific bereavement support group. It can be very beneficial for survivors. Individual therapy, family therapy, support groups. There is an education piece. 90% of people who die by suicide have a diagnosed or undiagnosed psychiatric condition, and what role that plays in the suicide. We talk about suicide being kind of like a brain attack. And we use the medical model. We talk about a heart attack versus a brain attack. And, you know, a heart attack can come after somebody has cardiovascular disease for a long time. But there are are other people, you hear it every year at the marathon. There’s a healthy 27-year-old running along that suddenly dies, and that is from an undiagnosed heart condition. And, so, there was just no warning signs. And that can be true with suicide, too, in the brain attack. And we do share that with individuals in the SOS group on this model.
– Do you find it’s helpful for family members to have that put in that medical context like that? Because I’ve never really heard of that before.
– For many. For many people it is, yeah. There are other things that people can do. Well, one, trauma-focused care. I think that is ideal if they can address it. Because this is a traumatic loss, similar to an accident, homicide, or natural disaster because it was so unexpected.
– Explain to folks what trauma-focused care means.
– Trauma-focused care really is kind of looking at the situation, what caused this loss, and applying appropriate therapeutic techniques. One of those is EMDR, and it is eye movement desensitization reprocessing. And, it’s guided by a therapist, a trained therapist. It’s a very specialized technique to help minimize the traumatic memories that people experience based on their loss. There are other things you can do on your own, too. Reading, it’s not for everyone, but do what works for you, No. 1, because starting something new might be difficult, but if you are a reader, per se, or a person that likes to gain knowledge about things in general, then reading might be a good thing for you. We had one mom in the support group who had read 27 books about suicide and suicide bereavement in the 10 months since her son had passed away. So, that was her go-to thing.
– Where can someone start to look for help?
– American Foundation for Suicide Prevention is an excellent resource, just short-term, AFSP. And you can Google that. They have a lot of resources available. They actually have a peer-to-peer connection there. And that is, especially because suicide bereavement is so unique, but so is the type of loss that you’ve had. And, so, say you lose a partner or a spouse, versus losing a child, there are no super-specific groups like that available. But AFSP does have a peer-to-peer, and what they will do is they’ll try to connect you with somebody who’s had a similar type of loss. And that can be very beneficial. Locally, in Pittsburgh, I can say UPMC Western Psychiatric Hospital, and specifically the SOS support group, is an option.
– And, so, what do you want to say to folks, too, about the resources that are out there if they are worried about a loved one when it comes to potential suicide?
– 988 is the Suicide and Crisis Hotline that is available for anybody in need in a crisis. American Foundation for Suicide Prevention is another good resource.
– And, so, bottom line, what do you want to say to people about there, in fact, being hope and help out there?
– It’s hard to see that in the early days, but, so, I think time is the biggest factor, that recognize and incorporate that in. And I think people really do want to feel better. People align themselves with the living, typically, and so that’s why they have all of this concern and angst anyway. And, so, I think that just seeking out the resources, and being kind to yourself. I think we’re our harshest critics. And I think that especially with a loss like suicide, we really overthink what role we might’ve played in that death. And, I think that we have to be kind to ourselves. I literally just bumped into someone who had been in the group a few years ago, and we talked for a couple of minutes. And, she spontaneously shared with me, she said, “You know what?” She said, “I still miss my son every day.” She said, “But I’m better. I’m better than I was. And I’m so appreciative of the SOS group.”
– Well, Kelly Monk, we thank you so much for coming in and spending time with us today. We certainly appreciate your insight on this really important topic.
– Thanks so much.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.