Death is the only certainty all of us have, but when it happens, finding the rights words to say or the right things to do can be a challenge. Don’t let your fear stop you from reaching out. Grief is hard for everyone but if you keep these two things in mind, chances are your efforts will be remembered:


It’s not about you.
Just show up.

For more than a decade, I have been interviewing families who lost loved ones. The sad irony about grief is that most of the time, these individuals are surrounded by friends and who want to help but don’t know how. They think about calling but don’t because they believe that giving breathing space is more helpful; they want to come over but the thought ‘what if it’s a hard day?’ stops them halfway. This creates frustration and pain on both sides.


If you are in this position or just want to be ready when it happens - yes, it will happen - here are some ideas of how to show you care:


Instead of saying ‘call me if you need anything,’ take the initiative. Grief hits you like a tornado, leaving a messy, broken world behind. Don’t expect the griever to have the energy to call or let you know about their needs. This is precisely the moment when you should take the initiative.



The thing about showing up is to stick to what you do best. This is something I have learned recently. I don’t know about you, but every time I have a friend in need, the first thing that comes to mind is to bring them a meal. Nothing wrong with that, it’s a great gesture, but I don’t enjoy cooking, never did, never will. Moreover, this is what most people do. There is a chance that your friend will have tons of food at home already, so find a service you can provide.


One way to decide on how to help is to think of all the things that can become overwhelming in their daily lives. Most of the time, these are simple chores that need to be done. Here are some examples:


- Laundry: clothes will certainly be piling up, especially if they have kids. Offer to do it. You can even text them to leave the bag by the door so that they don’t have to say hello. Believe me, this can make a huge difference.


- Mail: sort it out for them. Write down bills that need to be paid, the due dates and value; separate the sympathy cards they might be receiving. Help make a list of those that need to be replied, get the cards yourself, and just have your friend sign them. Mail the cards.


- Food: if you are not like me and that’s your thing, by all means, bring them food. It doesn’t even have to be cooked by you, just make sure you know what they like and be aware of any restrictions or allergies.


- Clean their home.

- Mow their lawn.


- Take care of their pets, particularly dogs because they need to be taken out for walks.


- Be the one to update your friends: having to call people so that they know how you are doing or to inform them about the wake, etc. can be daunting. Make a list of people you can contact and do it yourself so that some of the burdens can be relieved.

- If you are close enough, come to their home, take calls and receive guests during the first few days.

- Drive them where they need to go.


- Organize your community to help together: if you are good at getting things organized, go for it! When my friend Pepe told me about his cancer surgery, I realized that the following day I would be traveling abroad, so I contacted our closest friends and asked what each of them could do to be present for him. We created a spreadsheet online and each person added the days they would visit, which food they would bring, who would walk his dog, etc. I couldn’t be there for him, but I made sure everybody else would.


- If faith and religion are relevant to them, create a prayer group. Having them participate is their choice. A middle term would be to have them be present by a video or voice call.


If none of these hit a cord, find an area in which you can support them. Are you a lawyer? Then help them with legal matters; A teacher? Assist the kids with homework; Gardener? How about adding some beautiful flowers to their yard? Just do your thing, no matter what it is. The point is to be there.



Kids


Parents get particularly overwhelmed after a loss, but life goes on, and so do the endless chores that need to get done for the kids. Showing up for them is meaningful for both the parents and the children, who will learn the value of friendship and community in tough times.


- Take them to activities: Although it is important for the family to go through bereavement together, parents can benefit from having time to be alone, organize the home, and rest. Let them know which days you are available so they can plan accordingly.


- Entertain them: Take the kids for a day out or establish a day of the week to have them over.


- Assist with homework.


- Give them rides to parties, to school events, and friends’ homes. Wherever they need to go.Be ready to talk to them, bring up the subject: it’s common for kids to feel that they shouldn’t talk about their loss because it causes pain to their parents. Sometimes, they even feel guilty about the death but don’t know how to express it, so let them know that they can come to you.


The Don’ts


Being a source of comfort is not always about what you do. Knowing what to avoid can be equally important. Here is a list to keep in mind:


- Avoid talking about it on social media: grief is a private matter, so if you feel the need to discuss it with someone, call a friend. Let the family be in charge of online posts, particularly photos of them and the deceased.


- Don’t feel that you have to be the one to be positive about their pain: if they are having a hard day, just listen.


- No, you don’t know how they are feeling: sometimes we believe that because we have lost loved ones, the experiences can be compared. They can’t and when you switch the story to yours by saying “when I lost…” you make it about you. Unless they ask specific questions regarding how you dealt with your loss, just listen to what they have to say.


- Avoid imposing your faith: unless you know that religion and spirituality are important to them, don’t push your own beliefs on the bereaved.


- Don’t minimize it: even with the best intentions at heart, saying things like “it could be worse,” “at least you have your family,” or “you have a lot to be thankful for” can upset and make them feel that they are alone or that you are not ready to listen to them.


If the person mentions the deceased, don’t change the subject: silence is grief’s most constant companion. No matter how uncomfortable it may be for you, remember that it is much worse for them, so if there is a need to talk about the one who left, please listen. Few people do. The flip side of this is equally important. Be able to sit in with them in silence. Let them lead the way.


- Don’t say “you should”: instead, use less judgmental statements like “have you thought about…?” “maybe it would be helpful” and “you could try this…”


Finally, understand that grief follows no set path. It will look different on each of us, and that is totally fine. Respect their pace, their reactions, their pain.


Again, it is not about you.
Just show up.
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  • Paula Fontenelle

Among 10-14 year-olds, the US Suicide rates nearly tripled in ten years. What are the warning signs and how to approach this population

For most of us, the idea of a young child taking their own life is unthinkable, but unfortunately, from 2000 to 2017, this was the reality for more than five thousand families in the United States (5,527 deaths). And this is only for children within the 10-14 age group alone. If we look at the 10-24 year-olds, the numbers reach the alarming sum of 88,744 people. For this population, suicide is the second leading cause of death.


It gets worse. Since 2010, the suicide rates for the 10-14 age group practically tripled, so the natural question to ask ourselves as a society is why? What is leading these kids to such high levels of hopelessness that they see no solution for their pain?



There is no easy answer, and certainly, no one-size-fits-all, but some factors play a part:


1. Family dynamics - Researcher Johan Bilsen argues that approximately 50 percent of youth suicide is related to family factors, including communication patterns, neglect, violence, substance abuse, and history of mental disorders. Genetics may also play a role. Twin studies have shown a higher risk for those with a biological family history of suicide, even in kids who were adopted, which signals the impact of genetics. The association with parental divorce is weak and might be more closely related to the life changes provoked by it, such as financial difficulties, relational factors, and the implications of living in a single-parent family.


2. Young people are more vulnerable to mental health problems, particularly in adolescence, when they go through changes as they search for their own identity. Mood swings and heightened emotions are normal traits of adolescence. These are part of the individual’s search for self, as well as a natural response to increased responsibilities.


3. Brain development also plays a significant part in behavior during this phase. In the teenage years, the midbrain, where emotions are processed, is well-developed, while the formation of the connections of the prefrontal cortex, responsible for reasoning, are still underway. It is this area that allows us to plan, moderate social behavior, prioritize, and think logically. As a result, adolescents are prone to misinterpret social cues, act on impulse, and engage in risky behavior. This is where suicidal ideation may come into play.


Social media


The correlation between mental health and screen time has been the subject of an increasing number of recent studies. Establishing connections online is not necessarily negative. Quite the contrary—the benefits for the youth are many. It enables them to improve communication skills, to broaden their social network, and to develop new interests. The problems arise when the online environment substitutes for real-life relationships and activities when it highjacks a person’s capacity to look outside their screens and find joy elsewhere.


One of the aspects that can increase anxiety is the new concept of ‘Fear of Missing Out’ (FoMO), which consists of the worry that if you are not connected, you will be missing out on joyful activities as they happen. This leads to the constant need to recheck messages and posts online. FoMO is linked with lower mood and life satisfaction.


In the United States, a 2017 study conducted with 506,820 youngsters between the ages of 13-18 found that adolescents who spent more screen time had a significantly higher likelihood to experience depressive symptoms or have at least one suicide-related outcome.


Finding a balance between life on and off the screen is crucial. The study found that adolescents using electronic devices three or more hours daily had 34-percent more chance of having at least one suicide-related outcome than those using devices two or fewer hours a day. When visiting social media sites every day, teenagers were 13 percent more likely to report high levels of depressive symptoms than those who used them less often.


One of the factors that contribute to depression is the many popularity measures created by Facebook, which may lead to feelings of inadequacy when a young person sees their ‘friend’ having a good time. The researchers observe, however, that this is not true for all users. If well-adjusted, the effect may be the opposite: a boost in the adolescent’s positive feelings about themselves.



College students


In its 2018 Student Health Assessment, the American College Health Association asked 88,178 students to identify which factors had negatively affected their academic performance. Stress was placed at the top of the list with 33.2 percent, followed by anxiety (26.5 percent), sleep difficulties (21.8 percent), and depression (18.7 percent), all of which have a direct impact on mental health. Many do not seek help.


The data shows a concerning number of youngsters who need professional attention and support from their family and peers, but most people feel that they wouldn’t be equipped to take action. Knowing how to approach this population can make a difference in the manner in which they will respond, so I have gathered here some tips on how to address young adults.


Watch for


Academic problems: lack of interest, a sudden drop in grades, skipping class, difficulty concentrating, and aggression toward teachers and student peers. Behavioral changes: withdrawal, disregard for personal appearance, substance use (or increase of it), mood swings, risk-taking activities, self-harm/self-mutilation (mainly cutting), and eating changes. Speech: discussion of death and related themes, such as pain, suicide, and despair.


WHAT HELPS

Relationships are the most important asset. Stay close, offer non-judgmental help, and as much as possible (with consent), involve family, friends, teachers, faculty, or staff. Build an empathic community.


Healthy habits: adequate sleep, diet, physical exercise, health care, and counseling. Most colleges have mental health services for their students.

Parents, stay involved in their academic lives: If you have kids who are still in school, attend events that are relevant to them, such as dance performances and sports matches. If there are academic problems, talk to teachers and faculty. When in college, which many times means that they are out of state, connect with them by calling, texting, and video chatting. What they need to know is that you care. This is particularly important for freshmen because they are going through many adaptations, so they need to feel that family support is still there. When talking to your kid, avoid “right or wrong” comments. Ask open-ended questions (those that are not answered by a simple yes or no). This helps them open up to you.


Listen, listen, listen. Many times, what they need is to be heard, not necessarily to be given specific advice. Kids usually make it clear when they want your objective guidance. A good approach is to relate their problems to similar ones that you have had in the past. This is less intrusive than saying things like, “I think you should” Give them space to figure out what is best for them.


Whenever possible, and this depends on consent and your kid’s age, monitor their online activities. Set time limits. Using the internet is not a problem per se—much to the contrary, it is essential for their academic and social development. Using too much of it or substituting human contact by social media, however, is what raises concern.

Remember, sometimes children or adolescents who are thinking about suicide won’t tell you because they are worried about how you will react. Your direct, non-judgmental questions can encourage them to share their thoughts and feelings with you. Regardless of their response, if you suspect that the person may be suicidal, get them help immediately.


Warning signs


Watch closely if they:


Stopped enjoying activities they once loved

No longer attend classes or social outings

Are experiencing extreme anger or sadness over a relationship in their life

React negatively or with apathy to most things

Often talk about death or suicide


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  • Paula Fontenelle

The death of a loved one is one of the most painful experiences a person will ever face, but when the loss is by suicide, layers of suffering are added to the bereavement. The first and most common one is created by guilt, the ubiquitous feeling that haunts practically everyone who goes through this kind of death.


Guilt doesn’t necessarily have to be related to the death itself. Most of the time, it sends the griever back to the last moments before their loss, leaving them in search of all the things that could have been done differently. Suddenly, the unanswered text message from days ago holds a new meaning; the glitches in the relationship don’t seem to be as relevant as they were anymore, and a harsh word said in a moment of frustration makes us feel selfish and unkind.


Anything, big or small, opens the door for guilt to slowly creep in with its unforgiving claws.

Parents are particularly hit by remorse, no matter how involved and dedicated they were to the child they lost. When I interviewed Maria Cristina early this year, her only daughter had died by suicide fifteen years prior. Nevertheless, she revealed to me that she still cries in the shower, tormented by an endless list of ‘what ifs.



At the time of her death, her daughter Mariana was in her early twenties and had just finished college. Although she had been treated for depression as a teenager, everything pointed to a bright future. Mariana had a boyfriend, with whom she shared an apartment in São Paulo, Brazil, a few close friends, a career in the making, and a mother who was loving and present. Practically every weekend, she would drive an hour and a half to visit her daughter.


Their favorite place was “Liberdade”, a neighborhood in the heart of the city that is a sort of a Japanese version of Chinatown. Mariana loved the Japanese culture, especially their culinary, so they would walk around the area for hours, and then eat at a local restaurant. “She was blooming,” said Maria Cristina. In the week of her death, they had planned to meet on Friday to buy a costume for Mariana so that she could go to a Cosplay party. Her mom postponed it to Saturday because of a massive parade that would happen on Friday, which would certainly block the roads to São Paulo.


On Saturday morning, her daughter’s boyfriend called her saying that Mariana was not home when he woke up, so she immediately drove to her daughter’s apartment, but when she arrived, they had already found her body. Since then, guilt has taken on many shapes and narratives: 'I should have come on Friday, as planned' was the first, albeit not the only one.

The front lock of Mariana’s apartment had been broken for months. Whenever a person tried to open the door, it would get jammed and cause a lot of noise. The last time Maria Cristina visited her, she paid a locksmith to replace it, but instead of feeling good about it, this altruistic gesture became a source of guilt for her. “Maybe if I had not fixed it, her boyfriend would have listened to my daughter adjusting the key when she left early that morning, and maybe he could have stopped her,” she told me.


This is guilt in its purest form. It lingers on, waiting for the perfect moment to sink into a person's life. Guilt has the power to resignify acts of kindness and to destroy even the best of intentions.

Another trait of suicide grief is extreme isolation, which is created by many factors, such as the difficulty in sharing one’s pain, the fear of judgment, the shame, the fact that they may not know how to answer even the most basic questions surrounding the circumstances of death, and the blaming of others.


All these may provoke a personal shut down, a desire to hide from the world, but none is more central to isolation than the stigma that surrounds self-inflicted death. This inescapable reaction of others is maybe the most central element that constitutes the singularity of suicide grief, as Maria Cristina recalls:


“On the day of the funeral, several friends invited me to get together, but after that, I never heard from them again. I think they felt uncomfortable and didn’t know what to say to me. I’m not even included in my extended family’s gatherings anymore. Many of the parents I meet tell me the same thing, it’s pretty common,” she said, referring to members of the support group she attends weekly, in her hometown.


In the book Myths about suicide, the author Thomas Joiner argues that losing a loved one to suicide is frequently followed by a profound change in one’s address books “once trusted friends fall away after ignoring a loved one’s suicide or after saying hurtful and appallingly glib things like ‘It was God’s will.’” And it can even be more wounding than that. A few weeks after my father’s suicide, my younger sister was told that because of what he had done to himself, my dad would be in a horrible place for a very long time.


To avoid this type of remarks, many families choose to deny the suicide altogether by either engaging in lies or self-denial. Maria Cristina told me that she used to participate in an online grief support group for mothers. One of the members had lost a son to suicide but refused to disclose the truth. Every time she talked about it, the woman would mention a car accident as the cause of death. Maria knew it wasn’t true, but she kept it to herself. “One day, when I felt strong enough to share with them my daughter’s story, I was instantly blocked from the group, and couldn’t communicate with them anymore,” she added.


These are just some examples of what makes suicide bereavement singular. Unfortunately, there are many others. The bottom line is:


With each token of rejection, the bereaved retreats in his pain, and it is by avoiding friends and family members that he perpetuates the pernicious cycle of silence.
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