December 21, 2014 marked three years since Cliff's death. For the past six months I've been cycling, kayaking, and climbing, feeling strong. This year I made plans to go snowshoeing with one friend on the 21st and have dinner with another. I thought I would try being social on the anniversary of his death instead of isolating as I have done. But those plans fell through a few days before. Even an outing the previous day was aborted when our car hit black ice and spun into the ditch, leaving us stranded for a couple hours until a tow truck came to rescue us.
So events conspired to ground me. I'm never sure what to expect on these anniversaries. I think I'm doing well. I felt pretty normal as the day approached, other than noticing a decline in my physical stamina. That seems to be the most predictable sign of on-coming grief. Then I find myself feeling easily irritated and running into obstacles (like the car going into the ditch, things just not working out). Until I simply accept that grief is here and I might as well hole up for a while and ride it out, not try to make things any different than they are.
I get frustrated with that, too, that grief lasts longer than a day or two, that I'm not being as active as usual and I'm eating more, that I cry at unpredictable and often inconvenient times, that I know I seem rude or awkward at work when everyone else is excited about Christmas, that I'm not able to just put all this aside and be "normal". I guess this is a skill like any other -- learning how to be compassionate with myself through this and eventually, I hope, as a result being kinder and less irritable with others who are having a very different experience at this time of year.
Grief is another side of love, a different facet of the same diamond. I don't understand it, I don't yet have the wisdom to handle it skillfully, I don't know what to do with it. I love you, Cliff. I miss you. I wish more than anything that you were happy and healthy and here.
Thursday, December 25, 2014
Sunday, September 21, 2014
Express Your Support for Bridge Suicide Prevention Barriers
Dear friends -
Many of you may know that one of the most effective ways to prevent suicide is to restrict the access to means. Recently Dr. John Carsley, medical health officer for the city of Vancouver, wrote a letter to the mayor and council in support of the installation of suicide prevention barriers on Vancouver bridges.
In his letter, Dr. Carsley states that between 2000 and 20012, 122 people died by jumping from bridges in the Vancouver area. Others who did not die suffered grievous injury. He cites evidence that suicide barriers have been proven to be effective in preventing these deaths, and that there is no displacement to other means or locations. He cites the societal cost of a single suicide as being estimated between $800,000 and $1,000,000.
In light of this information, the case for investing in suicide prevention barriers seems clear. If you live in the Vancouver area, please consider contacting the mayor and councillors to express your support of this decision. You can reach the mayor and council by email at mayorandcouncil@vancouver.ca and the city manager, Penny Ballem, at penny.ballem@vancouver.ca
Below is the email of support I sent. You're welcome to plagiarize!
Many of you may know that one of the most effective ways to prevent suicide is to restrict the access to means. Recently Dr. John Carsley, medical health officer for the city of Vancouver, wrote a letter to the mayor and council in support of the installation of suicide prevention barriers on Vancouver bridges.
In his letter, Dr. Carsley states that between 2000 and 20012, 122 people died by jumping from bridges in the Vancouver area. Others who did not die suffered grievous injury. He cites evidence that suicide barriers have been proven to be effective in preventing these deaths, and that there is no displacement to other means or locations. He cites the societal cost of a single suicide as being estimated between $800,000 and $1,000,000.
In light of this information, the case for investing in suicide prevention barriers seems clear. If you live in the Vancouver area, please consider contacting the mayor and councillors to express your support of this decision. You can reach the mayor and council by email at mayorandcouncil@vancouver.ca and the city manager, Penny Ballem, at penny.ballem@vancouver.ca
Below is the email of support I sent. You're welcome to plagiarize!
Dear Mayor Robertson and Councillors,If you're not in the Vancouver area, you could contact your own city council to express support for a similar measure in your municipality.
As both an executive board member of the Crisis Intervention and Suicide Prevention Centre of B.C. and someone who has been bereaved by suicide, I am writing you to express my strong support of Dr. Carsley's recommendations on the installation of suicide prevention barriers.
A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. In fact, some of the most dramatic reductions in suicide rates have been due to means restriction. Dr. Carsley provides excellent data on the effectiveness of bridge barriers in this regard.
Dr. Carsley provides a quantified estimate of the societal cost of a suicide death. As someone who has been bereaved by suicide I can testify to how devastating a loss that can be, especially when there is evidence that the loved one's death was preventable, as many suicide deaths are. In light of both the financial and emotional toll such deaths take, the return on investment of installing bridge barriers seems clear.
I hope to see a favourable decision by council on this matter in the near future.
Sunday, January 5, 2014
Understanding how trauma affects the brain
Dear friends -
The theme of the Canadian Association for Suicide Prevention conference that Andrew and I attended in Winnipeg this past fall was traumatic experience and its relationship to suicide risk. Someone said to me recently that mental illness or injury is what happens when a person’s central nervous system is overwhelmed. I like the simplicity and concreteness of this definition. It brings it down to the level of a physics equation: If enough force is applied to a bone in a particular direction, the bone will break. The amount of force will depend on the shape of the individual bone, how strong or brittle it is, and the direction in which the force is applied. The same applies to people’s minds.
Some at the conferences talked of people they had known who had survived incredibly tumultuous and traumatic childhoods and many ups and downs in their adult years, but then died by suicide following what seemed like a much lesser event such as the end of romantic relationship or (as in Cliff's case) a perceived threat to job security. They hypothesized that this was because it was the straw that broke the camel's back, something that finally overwhelmed the person's remaining inner resources.
Since attending the conference, I’ve read an excellent book, Traumatic Experience and the Brain, in which David Ziegler describes the neurological damage that can be caused by traumatic experience and childhood neglect. He provides a helpful description of what traumatic experience does to a brain and the long-term consequences that can result. One presenter at the conference spoke about the increased suicide risk that occurs for some people with mild to moderate brain damage. Ziegler seems to be talking about a similar degree of neurological damage occurring as the result of trauma or childhood neglect.
Ziegler comments at several points in his book about the length of time it takes to do neurological reparative therapy with children who have experienced severe long-term trauma or neglect, and that government is increasingly reluctant to pay for that type of long-term treatment. If it takes one to three years for a young child to develop more functional relationships and more adaptive ways of responding to the world, how long might it take for an adult for whom beliefs, emotional responses, and patterns of reaction have become deeply ingrained? And where in our health care system are the provisions for that type of treatment and the people equipped to provide it?
He also says, "The most serious finding concerning the effects of trauma is that neglect appears to be the most pervasive and persistent form of trauma when considering implications with a lifelong trajectory.... The implications for safety, nourishment, and the pivotal issue of attachment can be profound." (pp.40-1) Yet those of us who haven't experienced childhood neglect, including many therapists, don't understand the reality of that experience and its affects, don’t take it as seriously as more dramatic events such as physical or sexual assault, and aren't equipped to treat it.
Not all people who are at risk of or have died by suicide were neglected or abused as children or have experienced traumatic events. For some, perhaps particularly teenagers and young adults, the onset of a severe mental illness can, in and of itself, overwhelm their internal and external resources leading to a suicidal crisis. For others, repeated or ongoing experiences of mental illness, particularly schizophrenia, bipolar disorder, and mixed anxiety-depression, lead to the same outcome.
It’s also apparent that mental injury in and of itself doesn’t necessarily heighten someone’s suicide risk. Victims of torture, for example, are generally found to still have a relatively low risk of suicide, while war veterans and victims of childhood neglect and abuse have a markedly higher risk. I wonder whether the difference is the degree to which each takes the blame for the trauma and their ability to cope with the resulting mental injuries — that is, the amount of shame the individual experiences.
What’s been important for me to learn through this:
The theme of the Canadian Association for Suicide Prevention conference that Andrew and I attended in Winnipeg this past fall was traumatic experience and its relationship to suicide risk. Someone said to me recently that mental illness or injury is what happens when a person’s central nervous system is overwhelmed. I like the simplicity and concreteness of this definition. It brings it down to the level of a physics equation: If enough force is applied to a bone in a particular direction, the bone will break. The amount of force will depend on the shape of the individual bone, how strong or brittle it is, and the direction in which the force is applied. The same applies to people’s minds.
If Internal + External Resources > Trauma, the result is Coping or Thriving
If Internal + External Resources < Trauma, the result is Mental Injury or Illness
Some at the conferences talked of people they had known who had survived incredibly tumultuous and traumatic childhoods and many ups and downs in their adult years, but then died by suicide following what seemed like a much lesser event such as the end of romantic relationship or (as in Cliff's case) a perceived threat to job security. They hypothesized that this was because it was the straw that broke the camel's back, something that finally overwhelmed the person's remaining inner resources.
Since attending the conference, I’ve read an excellent book, Traumatic Experience and the Brain, in which David Ziegler describes the neurological damage that can be caused by traumatic experience and childhood neglect. He provides a helpful description of what traumatic experience does to a brain and the long-term consequences that can result. One presenter at the conference spoke about the increased suicide risk that occurs for some people with mild to moderate brain damage. Ziegler seems to be talking about a similar degree of neurological damage occurring as the result of trauma or childhood neglect.
Ziegler comments at several points in his book about the length of time it takes to do neurological reparative therapy with children who have experienced severe long-term trauma or neglect, and that government is increasingly reluctant to pay for that type of long-term treatment. If it takes one to three years for a young child to develop more functional relationships and more adaptive ways of responding to the world, how long might it take for an adult for whom beliefs, emotional responses, and patterns of reaction have become deeply ingrained? And where in our health care system are the provisions for that type of treatment and the people equipped to provide it?
He also says, "The most serious finding concerning the effects of trauma is that neglect appears to be the most pervasive and persistent form of trauma when considering implications with a lifelong trajectory.... The implications for safety, nourishment, and the pivotal issue of attachment can be profound." (pp.40-1) Yet those of us who haven't experienced childhood neglect, including many therapists, don't understand the reality of that experience and its affects, don’t take it as seriously as more dramatic events such as physical or sexual assault, and aren't equipped to treat it.
Not all people who are at risk of or have died by suicide were neglected or abused as children or have experienced traumatic events. For some, perhaps particularly teenagers and young adults, the onset of a severe mental illness can, in and of itself, overwhelm their internal and external resources leading to a suicidal crisis. For others, repeated or ongoing experiences of mental illness, particularly schizophrenia, bipolar disorder, and mixed anxiety-depression, lead to the same outcome.
It’s also apparent that mental injury in and of itself doesn’t necessarily heighten someone’s suicide risk. Victims of torture, for example, are generally found to still have a relatively low risk of suicide, while war veterans and victims of childhood neglect and abuse have a markedly higher risk. I wonder whether the difference is the degree to which each takes the blame for the trauma and their ability to cope with the resulting mental injuries — that is, the amount of shame the individual experiences.
What’s been important for me to learn through this:
Neurological injuries are as real and debilitating as physical injuries, but more difficult to recognize.Knowing that one is injured — that there are real, physiological reasons for one’s experience and behaviour — and having others recognize this, too, can provide immense relief in and of itself. Knowing that it’s not your fault — that this isn’t just an individual failure to think positively enough or see things from the right perspective, it’s the symptom of a physiological injury — and that there are things you can do to mitigate or ameliorate your experience is a message that many more people who have survived neglect and trauma need to hear.
Two people can experience the same event and emerge with different injuries, or one may not be injured at all — this is just as true mentally as it is physically.
Effective treatment for neurological injuries is possible. As for most injuries, the potential for healing is greatest when treatment is received soon after the injury occurs, but treatment later in life can also be of great benefit.
The length and intensity of the treatment required is relative to the severity of the injury. Brief or solutions-focused therapies are not effective treatments for severe or long-standing injuries.
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