6 reasons why people commit suicide

by Alex Lickerman, MD

Though I’ve never lost a friend or family member to suicide, I have lost a patient.

I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which I’ve seen take many months or even years to wash out of some mouths.

The one question everyone has asked without exception, that they ache to have answered more than any other, is simply, why?


Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).

People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.

In general, people try to kill themselves for six reasons:

1. They’re depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense. They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease.

Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.

2. They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression — and arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.

Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.

3. They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is usually genuine, and whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.

4. They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them—but are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent who swallows a bottle of Tylenol—not realizing that in high enough doses Tylenol causes irreversible liver damage.

I’ve watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.

5. They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.

6. They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.

The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain survivors feel. Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure. Despite the abrupt way you may have been left, those don’t have to be the only two emotions you’re doomed to feel about the one who left you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.

Disaster and then Disease

By Elizabeth Batt

The International Federation of Red Cross and Red Crescent Societies, describes a natural disaster as a “sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.”

The earthquake in Haiti that occurred on January 12, 2010, caused death and destruction, the extent of which has yet to be realized. Sadly, Haiti’s problems might be only just beginning. Often following the initial aftermath of any natural disaster there follows a second wave of deaths, caused by disease.

Types of Disease Prevalent in the Aftermath of a Natural Disaster
When a natural disaster strikes to the extent that it did in Haiti, the infrastructure of a country is decimated. Fresh water supplies, sewage disposal and power is destroyed or severely interrupted. What remains is often contaminated, initiating a vicious cycle that cultivates communicable diseases. In a third world country like Haiti, where resources are already stretched thin and immunizations are not standard practice, the loss of life is certain to be much higher because they’re simply not equipped to deal with an incident of this magnitude.

The study, “Management of dead bodies in disaster situations.” PAHO; 2004, indicates that little threat for communicative disease outbreak is posed by actual human remains. The threat comes from the survivors themselves, the destruction of their surroundings and an inevitable crowding situation caused by displacement. Without a continuous fresh water supply, survivors are forced to drink polluted water just to stay alive. Aided by the lack of adequate sanitary conditions, these pollutants are ingested and then defecated back into the water source. It becomes a breeding ground for communicable diseases.

Water-related Diseases
Water-related diseases include infectious diarrhea or norovirus, salmonella and cholera. Noroviruses are transmitted through the fecal-oral route after the ingestion of contaminated food and water. Once infected, a person-to-person transmission can occur. Noroviruses cause diarrhea and vomiting that without adequate sanitization amenities, continue to perpetuate.

Salmonella is often referred to as food poisoning. It causes the same symptoms as norovirus and can be present in almost any type of food. Salmonella is transmitted through infected feces that come into contact with a food source. People can become carriers of salmonella, transmitting the disease for life.

Cholera, transmitted by the fecal-oral route has an extremely brief incubation period of just 2-5 days. It can cause acute diarrhea, dehydration and kidney failure. Of all water-related diseases, cholera is perhaps the most insidious and can kill an adult within hours.

Crowding-related Diseases
The three most common crowding-related diseases are meningitis, measles and acute respiratory failure (ARF). Meningitis causes an inflammation of the membranes surrounding the brain and spinal cord and can lead to permanent neurological damage. Measles is a highly contagious viral disease that can cause seizures and coma. The complications of measles can include blindness and brain inflammation. ARF has a high morbidity rate of 50-70% in both children and adults. Caused by inadequate gas exchange, oxygen levels drop and carbon dioxide levels rise. An effect of displacement, over-crowding issues and poor nutrition, ARF is a major cause of death.

Vectorborne Diseases
Vectorborne diseases are caused by “vectors” such as mosquitoes that carry malaria. Earthquakes and other natural disasters can change a habitat, as evidenced in Saenz R, Bissell RA, Paniagua F. "Post-disaster malaria in Costa Rica." Prehospital Disaster Med. 1995;10:154–60. This change in habitat can create conditions that are ripe for breeding, causing an upsurge in outbreaks of malaria. Children are particularly at risk of contracting malaria, a virus that in its most dangerous form, can affect the brain and kidneys. Dengue, also carried by mosquitoes, can develop into dengue haemorrhagic fever. The spread of dengue can be directly related to inadequate solid waste disposal and water storage. Without treatment, fatality rates can exceed 20%.

Haiti's challenges are far from over and despite aid being sent to this ravaged country, the death toll as it stands now, is certain to rise.

Teen Suicide Risk Factors: Parents Are Too Often Clueless

By Nancy Shute

Suicide is the third leading cause of death among teenagers, and it's a tragedy that can be prevented. Given that almost 15 percent of high school students say they've seriously considered suicide in the past year, parents and friends need to know how to recognize when a teenager is in trouble and how to help.

Parents can be clueless when it comes to recognizing suicide risk factors, or at least more clueless than teens. In a new survey of teenagers and parents in Chicago and in the Kansas City, Kan., area, which appears online in Pediatrics, both parents and teenagers said that teen suicide was a problem, but not in their community. Alas, teen suicide is a universal problem; no area is immune.

The teenagers correctly said that drug and alcohol use was a big risk factor for suicide, with some even noting that drinking and drug use could be a form of self-medication or self-harm. By contrast, many of the parents shrugged off substance abuse as acceptable adolescent behavior. As one parent told the researchers: "Some parents smoke pot with their kids or allow their kids to drink."

Both teenagers and parents said that guns should be kept away from a suicidal teen. But since parents said they didn't think they could determine when a teenager was suicidal, parents should routinely lock up firearms, the researchers suggest. That makes sense. Firearms are used in 43.1 percent of teen suicides, according to 2006 data, while suffocation or hanging accounts for 44.9 percent.

The good news: Both parents and teenagers in this small survey (66 teenagers and 30 parents) said they'd like more help learning how to know when someone is at risk of committing suicide and what to do. Schools and pediatricians should be able to help, but we can all become better educated through reliable resources on the Web. These authoritative sites list typical signs of suicide risk, and they also provide questions a parent or a friend can ask a teenager to find out if he is considering killing himself. Here are good places to start:

The American Academy of Child and Adolescent Psychiatry lists signs and symptoms of suicidal thinking, such as saying things like "I won't be a problem for you much longer."

The American Academy of Pediatrics urges parents to ask the child directly about suicide. "Getting the word out in the open may help your teenager think someone has heard his cries for help."

The National Suicide Prevention Lifeline provides free advice to someone considering suicide, as well as to friends and relatives, at 800-273-TALK.

The National Alliance on Mental Illness's teenage suicide page makes the point that talking with someone about suicide will not "give them the idea." "Bringing up the question of suicide and discussing it without showing shock or disapproval is one of the most helpful things you can do," the NAMI site says. "This openness shows that you are taking the individual seriously and responding to the severity of his or her distress."

How Suicide Cleanup is Taken Up

Suicide cleanup is a part of the broad based service of Crime Scene Cleanup which involves crime and trauma decontamination and restoring it to its previous state.

It is a a niche market in the cleaning industry and involves cleaning the biologically contaminated scene of one violent death like suicide, homicide or accidental death, or even the chemically contaminated anthrax exposed site or scene of a methamphetamine lab.

Broadly speaking, crime scene cleanup and suicide cleanup is almost same but there are few exeptions to this rule. Suicide cleanup requires some extra physical effort and psychological sensitivity that the technicians should be able to handle.

Following are some examples illustrating this. A suicide generally involves close range of weapon to body and so in-depth decontamination and thorough cleaning is required. The cleaners also have to handle family members who might be present at the scene searching for answers that why their beloved person decided to end his/her life. The technicians need to remove all traces of any evidence of a suicide so that no remains are present for family members and friends that might remind them of the tragedy. Restoring of a suicide scene also means clean and restore sentimental items that mean the lot to the family of the deceased and requires additional time and effort. On a visual inspection of any suicide scene you will generally find a lot of blood and bodily fluids, but invisible to the eye, a great amount of biohazard contamination is also bound to be there.

The suicide cleanup technicians have to search thoroughly in all areas, even those that can not be seen or accessed easily and remove all traces of them from the scene. Most suicide cleanup services have their staff trained in not only dealing up with decontaminating and cleaning up issues but also about dealing with family and friends with sensitivity and compassion. Since most of such companies work in association with leading insurance companies so they can even help you to bill the insurance company directly thus saving you all the hassles. A suicide cleanup consists of the following steps.

Firstly the scene should be evaluated. Next all contaminates should be located and decontaminated. A thorough search should me made again to decontaminate any traces of contaminates that might have been left out. All types of bio hazardous agents should be properly disposed of. Any microscopic remains should b treated with chemicals and the environment should be treated for odors.

Last but not the least all tools and equipments should be disinfected. But before you attempt to clean a suicide scene on your own it is always better to consult a trained professional first.

Crime Scene Leftovers Pose Problem For Sanitation

Call it the Case of the Bloody Mattress.

City sanitation workers in southwestern Kentucky were recently left with the problem of how to dispose of a bloody mattress put out with the trash.

The mattress came from a home where police say a 37-year-old man appears to have died from self-inflicted stab wounds. The problem came when trash collectors realized they couldn't pick up a potential biohazard, but didn't want to leave it by the side of the road in a residential neighborhood in Hopkinsville.

"This was an area of concern for us because blood is considered a biohazard and not only can our trash trucks not pick it up, but it could be dangerous for people in the community," said George Hampton, a route supervisor for Hopkinsville Solid Waste Authority.

The Kentucky New Era reports that the mattress disappeared by midweek, but sanitation officials didn't take it and were still trying to make sure it was properly disposed of. The location of the mattress remained a mystery at week's end.

Hopkinsville sanitation workers received an anonymous call reporting a mattress, possibly covered in blood, that had been set on a curb outside of a home. That was the concern of the anonymous caller, Hampton said, who said children in the neighborhood could start to play on the mattress and come into contact with the dried blood that might have diseases.

Because there was blood on the mattress, sanitation workers couldn't haul it off with the rest of the trash.

"It raises a question for us about where we take it from here," Hampton said. "Someone has to clean up messes like these and we can't do it."

Solid Waste Superintendent Bill Bailey said sanitation workers aren't allowed to pick up possible biohazards, including blood, from the side of the road. Instead, Bailey said, the department needs to call other landfills to see who will pick up and take the items.

"Sometimes we can process and wrap it in plastic and dispose of it that way. But other times we have to contact a company that deals with disposing of medical waste."

Charlotte Write, a spokeswoman for Stericycle, a national company that specializes in medical waste disposal, said medical waste is generally burned to kill pathogens that can live in dried blood.

"It is important to dispose of all medical waste, especially waste that comes from the body, so as not to spread diseases," Write said.

Hopkinsville Police Chief Guy Howie said the families must clean up the scene of a murder or suicide or pay to have it done.

"It doesn't sound very friendly, I know, but that's just how it has to be handled," Howie said. "Someone has to clean it up and someone has to dispose of all of this, it's just a matter of figuring out who. It's amazing that just one mattress on a curb can raise so many questions."

Someone solved sanitation's problem by taking the mattress from in front of the home. Bailey said sanitation workers didn't remove it, but finding out what became of the mattress is important. It had to be properly sterilized and disposed of.

"We can't just stick it in our landfill and be done with it," Bailey said. "Whether it's on that curb or not, it's still hazardous material."

Crime Scene Cleanup: What It Involves

A crime scene cleanup service is not without its complications. Crime scene cleaning encompasses restoring the crime scene to its original state. When a crime is usually discovered, crime scene cleaners are not called until after officers of the law, like the crime scene investigators, have done their jobs first and have given the go ahead for the cleaners to come in. If you intend to hire a crime scene cleanup company, you must make sure that they are well equipped and fit right to get the job done. A crime scene presents challenging conditions.

The Use Of Protective Gears:
Crime scenes can very well involve the use of hazardous or deadly substances. For safety reasons then, it has become imperative that crime scene cleaners use protective clothing, in addition to protective tools and gadgets. You must see to it that they have all the necessary protective gears and gadgets. The protective clothing can consist of disposable gloves and suits. A disposable gear is preferred nowadays since it offers the best protection against contamination. You use it one time and get rid of it. That way, the dangers of contamination is virtually brought down to zero percent. Protective clothing extends to respirators and the use of heavy-duty industrial or chemical-spill protective boots.

Among the gadgets that a crime scene cleaning company must have are special brushes, special sprayers, and wet vacuum. These special tools ensure added protection against getting into contact with the hazard could very well be present in the crime scene. There is large, special equipment such as a mounted steam injection tool that is designed to sanitize dried up biohazard materials such as scattered flesh and brain. You would also need to check if they have the specialized tank for chemical treatments and industrial strength waste containers to collect biohazard waste.

Of course, any crime scene clean up must have the usual cleaning supplies common to all cleaning service companies. There are the buckets, mops, brushes and spray bottles. For cleaning products, you should check if they use industrial cleaning products. A crime scene cleaning company must have these on their lists:

1 - Disinfectants including hydrogen peroxide and bleaches - The kinds that the hospitals used are commonly acceptable.

2 - Enzyme solvers for cleaning blood stains. It also kills viruses and bacteria.

3 - Odor removers such as foggers, ozone machines, and deodorizers

4 - Handy tools for breaking and extending such as saws, sledgehammers, and ladders

Established crime scene operators also equip themselves with cameras and take pictures of the crime scene before commencing work which. The pictures taken may prove useful for legal matters and insurance purposes. You never know which.

Needless to say, a specially fitted form of transportation and proper waste disposal is also needed. These requirements are specific. As you can imagine, crime scene cleaning is in a different category on its own. A home cleaning or janitorial service company may not be able to cope up with the demands of a crime scene. A crime scene cleanup service requires many special gears and tools that a home cleaning or a janitorial service company does not usually have or does not require. Crime scene cleaning if not done correctly can expose the public to untold hazards.

What Else To Look For In A Crime Scene Cleanup Company
You may also want to hire a company that has established itself. An experienced company with a strong reputation is always a plus but it could be expensive too. You will do well to balance your needs with what is your budget. There are several companies that offer specific prices such as for death scene clean up categories and suicide clean up categories. Most companies own a website and have round the clock customer service as receptionists.

When looking for a suitable crime scene cleaning service, among the first things you need to do is to scout for price quotes. Crime scene cleanup services usually provide quote after they have examined the crime scene and then they give you a definite quote. Factors that are usually considered include the number of personnel that will be needed to get the job done. It also includes the amount of time that might be needed. The nature and amount of the waste materials that need to be disposed will also be factored in. You can be sure that the more sophisticated equipments needed the more expensive it will get.

Crime Scene Cleanup And Your Insurance
For homeowners, the best approach is always to make sure that crime scene cleanup services clauses and provisions are written down on the contracts or policies. The inclusion of crime cleanup services clauses is very common and has become standard clause in most homeowner’s policy. Make sure that you are covered for this unforeseen event. Make sure that your policy directs the crime scene cleaning company to transact directly with the homeowner insurance company. A crime scene cleaning service is usually a standard clause in many homeowners’ insurance clause. These companies often do the paperwork in behalf of clients.

If for some reason you do not have such coverage by any policies relating to crime scene cleanup on your home, there are ways to keep your expenses controlled.

Finding the right company can be very taxing, especially that you have to deal with the emotional stress stemming from the crime itself, especially with a crime scene involving death.

There are many crime scene cleanup companies in operation nowadays. There are reliable professionals that you can hire and prices are relatively competitive. As of recently, crime-scene cleanup services can cost up to $600 for an hour of their service. A homicide case alone involving a single room and a huge amount of blood can cost about $1,000 to $3,000.

In recent years, crime scene cleaning has come to be known as, "Crime and Trauma Scene Decontamination or CTS. Basically, CTS is a special form of crime scene cleaning focusing on decontamination of the crime scene from hazardous substances such as those resulting from violent crimes or those involving chemical contaminations such as methamphetamine labs or anthrax production. This type of service is particularly common when violent crimes are committed in a home. It is rare that the residents move out of the home after it has become a scene of a crime. Most often, the residents just opt to have it cleaned up. That is why, it is very important to hire the best crime scene cleaning company out there. The place needs to be totally free from contamination of any kind. You have to make sure that the company is able to remove all traces of the violent crime that took place. This includes cleaning biohazards that are sometimes invisible to the untrained eye.

Legally speaking, federal laws state that all bodily fluids are deemed biohazards and you should make sure that the cleanup service company you hire understands this and includes it in the cleanup. These things appear as blood or tissue splattered on a crime scene. You must be able to hire a company that is equipped with special knowledge to safely handle biohazard materials. The company must have the knowledge what to search for in any give biohazard crime scene. For instance, the company should be able to tell clues such that if there is a bloodstain the size of a thumbnail on a carpet, you can bet that there is about a huge bloodstain underneath. Federal and State laws have their own laws in terms of transport and disposal of biohazard waste. Make sure that the company you hire has all the permits necessary.

It will also be a huge plus if you could hire people who not only has the special trainings but also who have the nature to be sympathetic. If you are close to the victim and have the cleaning done at the behest of the victim’s relatives, it would matter that the cleaners tread the site with some level of respect. It is a common site that family members and loved ones are often there at scene. In general, when looking for a suitable crime scene cleaners, you would take into considerations the kind of situation that the crimes scene presents and the demands that it require. Crime scene cleaning companies handle a wide variety of crime scenes and prices may vary from one to the other crime scene and one to the other company.

Each type of scene requires its own particular demands not only to make the crime scene look clean and neat on the surface but to make it germ free, and clean inside and to make it free from all deadly and infectious substances. The cleanup cost for biohazards may vary depending on degree of the bio hazard(s) on the scene. There may even be a category that changes the cleanup pricing which usually involves decomposing bodies and carcasses. Likewise, a cleanup of chemical hazards vary, depending on the amount of chemical hazards as well as the grades i.e. how hazardous the substance is in terms of human contact. Prices are also determined by the number of hours and personnel that it would to get the crime scene cleaned. In addition, the "gross factor" from crime scene involving death and gore needs to be taken under consideration regarding the chemicals that will be used as opposed to those crimes' that do not have gore involved.

Traumatic Grief

By Nancy Crump

Since the late 1980’s, we have seen an increase in interest and research on the effects of trauma on the grief process. We have learned that the grief process from the sudden, unexpected, and often violent deaths of suicide, homicide, auto accidents, natural disasters, and other types of deaths, is very different from the grief process of those who have died from natural causes, old age, or long-termed illness. Many, if not all, of the deaths faced by Bio Technicians fall into the category of traumatic. Those family members who hire you have usually been touched by the trauma of the death. Understanding the traumatic grief process and its differences from other types of grief may be of some help to you as you deal with these family members.

There are several key elements that make the responses by family members to a traumatic death difficult. First is the suddenness of the death. Family members usually did not have time to prepare themselves for the death and to make the psychological adjustments to cope with the news of the death. Also, the suddenness of the death does not give the family an opportunity to say goodbye to the victim before their death. Second, the violence of the death may leave the family with horrific memories and nightmares that often interfere with the grief process. Third, many of these types of deaths require police intervention and the family is often not given the support, information, and compassion they need at the time. Another element can be the presence of the media at the time of the death, as well as weeks and months later if legal issues follow the death. Most traumatic deaths involve young people who’s parents, grandparents, and siblings may still live. Certainly, the death of a child or young person is very difficult to cope with.

Reactions to a traumatic death can be very different, more intense, and longer lasting than other types of death. The emotions following a traumatic death are often conflicting and intense. There is a tendency to relive the death event over and over in an attempt to make it real. Intrusive thoughts and nightmares are very common. Intense physical responses such as inability to eat or sleep, stomach aches and headaches, muscle tension, high blood pressure and a decrease in the autoimmune system are also common. Many times, the survivors must deal with intense feelings of guilt or remorse, feeling that they were somehow responsible or could have prevented the death “if only”. Family members have the need to tell the story of the death over and over again in an attempt to gain a sense of the reality of the death. They often have an overwhelming need to learn all they can about the circumstances of the death - how the person died, whether they were in pain, did they know they were dying, what were their last words, who saw what happened, and in cases of homicide, who committed the murder. All of these reactions are ways the survivors use to grasp the reality of the death and to begin the grief process.

As Bio Technicians, you are often called by family members or meet them upon arrival to the scene. Understanding some of the dynamics of trauma on the grief process may help as you help the family. Understanding the “normalcy” of the reactions you may see can help you feel more competent and assured to speak with family members without wondering whether or not you are saying the “right” thing. Some suggestions are listed below, but the most important thing is to convey sincerity and compassion to the family. They are very vulnerable and sensitive to words, expressions, and body language. Just make sure that what you say and do is congruent with how you feel or you will come across as insincere and uncaring.

Soon after a traumatic death, most survivors simply need to tell the story to anyone who will listen. It is important for their recovery to be able to do this. If you have time to listen, do so. They are not necessarily looking for any input from you; they just need someone to listen.

Remember that there are two basic rules for grieving people – you don’t hurt yourself or someone else. If, during the conversation, you hear comments that indicate the person is thinking of either, you might suggest they go talk to someone else before making a decision to do something like this. Create a list of counselors, therapists, or mental health centers to hand out at times like these. Take comments about thoughts of suicide seriously and offer to call a friend or family member to be with the person and get them help. Suicide rates often increase after a sudden, traumatic death of a loved one. These are very difficult situations for you as a caregiver, but you need to set limits as to what you can and cannot do. Listening and having resources available are all you need. The survivor needs to take some responsibility for them, and others who are better trained to handle these situations need to be contacted.

Although many reactions may look and feel “crazy”, most are normal reactions to the situation. Again, as long as they don’t hurt themselves or someone else, they are probably reacting normally to an abnormal situation. Helping normalize these reactions is very helpful to the survivor. Encouraging the survivor to talk and to express what they are experiencing is also helpful. Making a simple statement such as, “I think I’d feel the same way if this happened to me”, helps the survivor feel less out of control.

There are many support groups available to survivors that would make a good resource for them. Creating a list of those in your community or in nearby communities is a great gift for survivors. They may not want to attend a support group, but usually someone from the group is always willing to talk to them by telephone or offer assistance.

In the work you do, you may find yourself in situations of dealing with survivors who have needs you do not feel comfortable or competent in dealing with. That’s okay as it is not your responsibility to be all things to all people. However, there are these simple steps you can take to help your families in a meaningful way. You can listen. You can refer. You can offer resources. Having some general knowledge of the traumatic grief process may make you feel more competent in dealing with your families and knowing that you are being supportive and helpful in a meaningful way.

Below are some national organizations that offer support groups in almost every locality. They are specific to either the type of death or the relationship to the person who died and are more appropriate to traumatic deaths. They all have web sites or central telephone numbers that can be contacted for local information.

The Compassionate Friends – for parents’ whose child has died of any cause.
MADD – Mothers Against Drunk Drivers offer support for parents who a drunk driver killed child
Widowed Persons Service – sponsored by AARP for spousal death
SOS – Survivors of Suicide support groups
POMC – Parents of Murdered Children and other victims of homicide.

These and many other groups may be listed at your county’s Victim Assistance Office usually located in the office of the District Attorney. Also, check with your local hospices or hospitals. They offer support groups that are open to the public. Some local churches may also host support groups. As you create your list, don’t try to keep up with the dates and times of group meetings as they change frequently. All you need is the name of the group, a telephone number, and possibly a contact person. Leave it to the survivors to take the responsibility to make the calls on their own behalf.