By Monique Giard

As a survivor of my sister's suicide, what became clear to me is the importance of telling one's story as part of the grieving process. This process is too often shrouded by stigma and silenced by shame. I write this article at this intense time of year with the hope that by sharing my story and talking about suicide openly, you might learn a little bit more about suicide, which might help you assist someone in distress and guide you to save their life.

As a survivor, I often felt isolated and weakened by a strong stigma. After the suicide death of my sister in 1994, she was then 49, I would have liked to be able to speak about it openly with my siblings as I was attempting to reclaim the "truth." It took almost 10 years for that healing process to complete itself.

During my recovery, I learned that survivors who feel strong and safe enough to break the silence and openly tell friends, family and colleagues that a loved one died by suicide, not only helps their own bereavement process, but also contributes to more understanding and knowledge of the phenomenon, instead of maintaining the myths that grow in silence and denial.

Research shows that of the 4,000 suicides annually, the greatest number take place during the months of May, August, November and December. In Canada, in 1999, suicide was the leading cause of death in men ages 25 to 29 and 40 to 44 years, and the leading cause of death in women ages 30 to 34 years. Suicide is the second leading cause of death in youth ages 15 to 24 years.

According to a report prepared by the Royal Commission on Aboriginal Peoples (RCAP), the Aboriginal youth suicide rate is five to six times higher than that of non-Aboriginal youth. It is estimated that a suicide intimately affects at least six other people. Without support, these survivors are themselves at lifetime-increased risk for suicide, drug and alcohol abuse, or other significant negative impacts on their lives. (Data from CASP News 2003, American Association of Suicidology 1997 and BC suicide prevention program, department of psychiatry, UBC, 1997).

Suicide is surrounded by myth. One myth is the belief that suicide is the result of a single precipitating factor as opposed to being a complex psychosocial issue. Another myth is the belief that suicidal ideation is the result of mental illness. Although that can be true, it would be irresponsibly simplistic to think that way. Research is discovering the link between bullying and suicide called "bullycide."

Colonization and the rapid sociocultural changes imposed on First Nations' communities with consequent cultural discontinuity, play a large role in the high rate of suicide and suicide-related behaviours among Aboriginal populations. Research also shows a link between suicide and immigration, discrimination and racism. Other forms of oppression against lesbian, gay, transgendered, bisexual people are also part of the suicide puzzle. It is a complex issue and a collective cultural concern. The medicine wheel is my favourite model in understanding imbalances (emotional, spiritual, physical and cognitive) and the journey of recovery and wellness with its multilayered and holistic approach.

Very often survivors and clinicians wanting to explain someone's death, speculate that the person's suicide is the consequence of a single spectacular and dramatic event (like the breakup with a partner, marital problems, loss of employment, school failure, poverty, etc.). Although all these factors may be legitimate stressors and suicide risk factors, there might also be undiagnosed mental and physical illnesses as well as other childhood traumas that have never been resolved. These unspeakable factors are also stigmatized issues, like incest, the residential school syndrome, severe change in social or economic status, sexual identity issues or other psychopathology as taboo subjects in general. Keeping these factors as secrets in the family or denying high stress factors on a particular community or circle of people only serves to perpetuate the myths and prolong our misunderstandings about suicide.

Suicide survivors, like myself and approximately 24,000 other Canadians annually, often struggle for many years, to find reasons why someone would even consider death by suicide. What other options were available? What if one of these other options had been considered? All these questions make the grieving process last even longer. However long the process, this search for meaning, safe sharing with others and time, helps diminish the suffering. It was when I heard other people's stories, knowing that it was not their fault, that guilt over my sister's suicide started to go away.

Aftermath of suicide

After my sister's death, I became obsessed with finding the causes of her despair, forgetting my own grief. Thus also began my journey into the world of suicide prevention, becoming a counsellor specializing in it.

It seems that only other survivors can truly know the depth of despair experienced. Peer support is invaluable in the healing process of families dealing with the suicide loss of a loved one. I felt a lot of compassion, love and non-judgmental listening from the bereavement support group as I spoke of the loss of my sister Louise. I never felt stigmatized as mentally ill or thinking they didn't understand, as many survivors fear when seeking help from professionals. This fear of being judged, shamed, blamed or embarrassed may also be why survivors might avoid seeking help altogether.

Stigma also persists when a parent has to choose to tell or not tell children who have lost a close relative or friend to suicide. Parents may want to protect their child from the pain, however, similar to talking to children about sex, my advice to parents is to never lie to a child. That doesn't mean telling descriptively all the details of a suicide but using one's judgment in explaining what happened.

Another troubling concern is the heroic or romantically pictured aspects of suicide. Although it is true that suicide both fascinates and repels I believe we need to refrain from making this death spectacular, as it only increases the copycat effect. Dramatically and graphically describing suicide is not only disturbing but increases the risk to vulnerable people. There have been many studies on the contagious aspect of suicide copycats mostly with child and adolescent suicide. Emphasis should be on the fact that suicide is the act of a troubled person. It should never be presented as a means for coping with personal problems.

I think the most difficult thing to do when you have lost a loved one through suicide is to ask for help. Your closest friends, though they might try, can rarely understand the profoundness of pain and despair. However, in talking openly about it, and thus becoming better listeners on this difficult subject, I hope to increase our social responsibility in that regard.

I remember feeling isolated and guilty for not having prevented my sister's death one way or another (irrational feeling of failed responsibility). Guilt combined with incomprehension is what I think makes suicide different from any other death. It's very hard to make any sense of it. All the Whys? and What ifs? that you can think of remain with you for such a long time.

Last summer I visited my siblings in Quebec hoping to have closure around our sister's death. We cried together and hugged and cried some more thinking how much we miss her. It took nine years to be able to do that. That's a long time. That's how much stigma there is around death by suicide, which is very regrettable.

However, there is hope. More survivors are discovering it's safe to share their stories with friends and families, more survivors are making themselves available to help other survivors, and more survivors are having success in educating their clergy, physicians, teachers and the wider community. The stigma is lessening, the grief journey no quite as alienating.

Public action
How to minimize the impact of suicide on those left behind and reduce the number of suicides:

1) Know the warning signs, risk factors, or precipitating events of suicide, as indicated in the box, so you can take care of yourself or a distressed person. Suicide risk factors, warning signs and precipitating events

. History of previous
suicide attempts
. Frequent suicidal talk
. Extreme mood swings
. Sudden life style changes (activities, manner of dress or expression)
. Withdrawal or isolation from peers, family, or school activities
. Loss of a special friend, parent, sibling, or family relative
. Loss employment
. Loss of quality of life through illness
. Giving away prized possessions
. Putting affairs in order (uncharacteristic cleaning of room or sorting affairs)
. Decline in performance at school or at work
. Significant change in sleeping habits and energy level
. Increase in use of drugs, alcohol or medication
. Unexplained absences (from school, home, work)
. Significant changes or neglect in appearance and hygiene

2) Seek help from a physician or one of the agencies listed at the end of this article. Fight isolation and reach out to a physician, friend, family member, suicide survivor, or someone you trust. According to clinicians, talking about personal problems, including the desire to die, is much more likely to deflect suicide than provoke it.

3) Know what to do if you sense that a family member, friend, or colleague is suicidal. Be present. Our best attitude is to increase our awareness of how to be present and assist a suicidal person in need of immediate help. Being present can be demanding and draining so contact SAFER for telephone support and/or take advantage of its concerned others program.

If you know of someone contemplating suicide:

Ask direct questions: "Are you thinking of killing yourself? If Yes then, "How do you intend to do this?"
a) Be a supportive listener
b) Offer help, remembering it isn't your job to fix their life or solve their problems
c) Help them help themselves to connect with a relative or family physician
d) Call the crisis centre or SAFER for information and support for both you and the suicidal person
e) Be firm and focused. Never promise to keep a suicide plan a secret. Never leave a high-risk person alone. Take them to hospital emergency if necessary (From Crisis Intervention and Suicide Prevention Centre of BC)

In the process of helping a suicidal person or assisting a survivor of suicide, the helper may become depressed and suicidal as well. It is important that you take care of yourself and avoid becoming a helpless helper.

If you suspect that it is not safe to leave the suicidal person alone, take them to hospital emergency. Create a network of caring people who can be there as extended family members when needed. Since many people nowadays travel, immigrate, or move away from their families for work, studies or quality of life (i.e., refugees) it is not uncommon that suicidal people feel isolated. In any of those cases, creating a network of caring people might save someone's life.

Having a suicide plan increases the risk of completed suicide as opposed to attempted suicide. In a CASP conference I remember people saying that they did not feel comfortable asking the question, "Are you thinking of killing yourself?" If you choose not to ask so directly, make sure to ask what is going on. Many suicide survivors deeply regret not having asked more questions.

Many young people feel a strong sense of loyalty among their peers and would rather not tell when someone has disclosed an intention to die by their own hand. Ask yourself if you would rather have a friend angry with you for telling or live with regrets for not telling anyone and have a dead friend? Confidentiality, and this is true for counselors and clinicians, will be preserved except under certain circumstances such as a perceived risk of self-harm.

4) If you have lost someone to suicide contact SAFER or the other support groups listed at the end of this article. Take advantage of employee assistance programs, school counselling services, or join a healing circle. Find ways for creative healing: read healing books, join an art, acting or dancing class, write a personal journal and definitely consider joining the BC Survivors as Advocates Coalition.

5) If you live close enough to a suicidal person, take away any means to self-inflict death: firearms, medication, ropes, etc. It has been proven in Qikiqtarjuaq, Nunavut that taking the closet rods from every house in the community and removing locks from bedroom doors, has reduced the rate of suicide among Inuit youth.

6) In case of high risk and when hospitalization is not possible, offer close supervision. The availability of close supervision in the home must be assured in case of high risk.

7) If the suicidal person is of First Nations origin, you might want to direct them to a culturally sensitive counsellor or psychiatrist through the Vancouver Native Health Medical Walk-In Clinic, DEYAS Counselling Services or Arrows to Freedom Cultural Healing Society.

As I read the second last chapter of Carla Fine's testimonial book, Forgiving Them/Forgiving Ourselves, I find myself sitting outside at my friend's beautiful house in Lions Bay, overlooking the ocean and mountains, enjoying a late sunny and warm afternoon, surrounded by the smell of cedar trees. Peacefully and inspired by Carla's writing, I reflect on my closing words for this article. Even though I would have liked to believe that, through love, we could keep the people we care about alive, I know we can't and forgive myself for that. My closure on my sister's suicide would not be complete without also forgiving her for leaving this world the way she did.

For more on the subject of suicide contact the following:
. SAFER Counselling Service
604-879-9251
. Crisis Intervention and Suicide Prevention in BC 604-872-1811
. B.C Survivors of Suicide as Advocates
Coalition http://groups.yahoo.com/group/ SurvivorAdvocates
. The Canadian Association for Suicide Prevention (CASP)
SuicidePrevention.ca
. Vancouver Native Health Medical
Walk-In Clinic 604-255-9766
. DEYAS Counselling Services
604-685-7300
. Arrows to Freedom Cultural Healing
Society 604-434-0411
. Multicultural Healing Circle Fridays
7pm, 1254 West 7th Avenue.

On bullycide visit the website moniquegiard.com

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