- So it's for me, people that have been down this river, and now they don't realize they've turned into guides for the new people that come in.

They see themselves still going down the river, but they don't realize how far down the river they've gone, and now they're beginning to guide other people safely through some rapids that they experienced when somebody else guided them.

You see, this is the thing.

We don't realize we carry wisdom that we've earned in the hard way.

But when you share that wisdom, it multiplies.

And that's what's so beautiful to see.

(gentle ambient music) Suicide is complicated, and the bereavement is complicated, but part of what complicates it is the just ignorance about what suicide really is like for people who are out there struggling with life and death things.

(gentle ambient music) Part of that was this legacy of using the word "commit" in front of suicide.

People don't commit cancer, they don't commit heart disease, they die from these things.

People die by suicide.

So there is no reason to use that word.

It's not an illegal behavior, it's not murder.

This is somebody dying, so they died by suicide.

(gentle music ending) (gentle ambient music) - The American Association of Suicidology was formed in 1968.

We are the nation's oldest and first suicide prevention entity.

Our mission is to bridge research to practice, but to really do that in a way that empowers local communities to develop strategies that speak to the needs for preventing and intervening in suicidal thoughts among people.

AAS came to be to elevate, really break the stigma, elevate the conversation with a topic that for so long, people just didn't talk about, and the shame, and the grief that families carried, without a place to go.

- What's different about suicide is the social stigma that's been going on for thousands of years, where officially, the families were blamed and punished for suicide.

They were held accountable for suicide, because it took a taxpayer out of the monarchy's realm.

So it moved to this place, where punishing people, and saying, "Well, that family, they have illness in their family.

Someone died by suicide over there, something's wrong in that place."

- Suicidology is really the science behind suicide, right?

I mean, why people die by suicide is so population-specific, situational-specific, everyone thinks like it's one thing.

There's this kind of, it's always mental illness.

We harm suicide prevention when we connect it as like, "Well, they have a mental illness, so they were suicidal", rather than "Suicide can impact any one of us if enough negative things or we feel negative things have happened."

I think that's why it's important to talk about suicide, it's why it's important to get people more comfortable understanding.

A lot of people are afraid, "If I ask for help, they're gonna make me go somewhere", rather than "I could talk to someone, and that would be what I need without the fear I might lose my job, or I might be hospitalized, or ..." Those fears are real fears, and reasons why people often hold them in.

- For a long time, I've advocated that we consider suicide a public health issue, because there's a sense of contagion that can occur following suicide that has nothing to do with mental health issues.

And we have a lot of people who die by suicide that really don't have a mental health issue, a diagnosable mental health issue preceding their death.

So I think if we use crisis theory and bereavement, for example, as a way of looking at that, anyone could run the risk of being in a place, where they're thinking about suicide.

(gentle ambient music) Crisis theory tells us that in every crisis there is both danger and opportunity.

So think of it as a fork in the road, where you get there, because something happened in your life that you weren't able to cope with using the normal coping behaviors that you have.

So let me go back to the idea of a person's going along in life, and things are going okay, they're having their ups and they're having their downs, but they're able to cope with most of the events in life without it affecting their activities of daily living.

Then something happens for that person at that age that is more than they can cope with.

So they go through a period of time over days and weeks, where their ability to cope, sleep, eat, take care of themself keeps declining.

And so as they keep declining in their ability to cope, then other things that happen become more too much, "Way too much for me to cope with."

So they're beginning to get to the place, where they can't even do things they did in the past pretty easily.

And when we're not sleeping, and we're not eating, we engage in faulty thinking on a regular basis.

- It is a human condition.

We all experience moments, where we're like, "I don't know if I can take this anymore," whether it's a devastating breakup, an unexpected job loss, or a whole bunch of things at one time, or a bunch of little things at one time.

- So if I've got this hazardous atmosphere of life bearing down on me, and the supports that I've always depended on seem to be failing under the weight of this crisis, what happens is my ability to cope declines to the point, where I might begin to think suicide is a way for me to cope with all this trouble.

(gentle ambient music) Imagine a person in crisis is in so much pain that all they can want is relief, and they come to a place where even though there's a part of them that wants to live, there begins to be some hopefulness that dying could stop the pain.

And the pain is what was referred to by Edwin Shneidman, the father of suicidology, as "psychological pain", he called it "psychache", and it's every bit as debilitating as any physical illness.

But with psychache, the pain is intense, and you don't see a way out of it, but you have a hopefulness that by dying, you would be out of that pain.

So they have an ambivalent thoughts, meaning both wanting to live and wanting to die.

And they're struggling with these two things.

They're competing with their energy.

And what folks will say honestly is the not knowing is what was so hard.

And so once they make the decision, even if it's a decision to die, they at least now relax, because they're no longer ambivalent.

And this is why we often hear people say, "But he was doing so much better lately.

He seemed to be happier, be in a much better place."

So that's what ambivalence is about, being pulled between opposite emotions.

This idea of ambivalence is one that people have struggled who have had it all their life until somebody explains, this is a common phenomena for people who struggle with suicide.

It's a common phenomena people struggle about whether to buy a house or whether to buy a car.

Ambivalence is something we all experience.

We just call it "mixed feelings."

So these are mixed thoughts, and these are thoughts that if taken to action can kill you.

People are constantly making decisions to live, and dying by suicide 10 feet from where they last made a decision to live.

See, we see doctor's appointments, we see clothes bought, we see Christmas cards written, we see all kinds of signals toward life at a death scene.

This is what is so confounding until you understand ambivalence.

This ability to wanna live and simultaneously wanna die is a dynamic that is constant for that person.

(gentle ambient music ending) Quite often, when people come in for help, they believe that dying is the only way to relieve the stress in their life.

So when we can say to them, "If we can help you get out of the pain, but still live, are you willing to work on that?"

And they go, "Well, of course I am.

I would much rather live than die, but I just can't see a way out of this."

And I think the metaphor there is that they've got their face right up against a black wall, and in that place, you can't see much to the side, and you sure can't see much in front of you.

And what we're doing is helping them just take a step back, and let a few more things come into their life that are real, supports that exist in their life, people they haven't talked to, and for me, the things I'm wanting most is sleeping, and eating, and having some social supports that know about their battle.

It's hard to hear this kind of information, but it's important to know that suicide is not a forever state of mind.

People can change and return to living.

And so that when someone says, "I'm thinking about dying," that is not a time to be hopeless.

That's a time to be helpful, and get them to help with somebody trained to help them find ways to live, to end that psychological pain and suffering.

So when we look at crisis theory, the danger part is about death, about dying.

The opportunity is about living, and living in a way that you cope at a higher level in the future, so that you actually are creating a safety zone between a next crisis, because the one thing we can depend on in my experience, and I've lived a long time is that every crisis isn't the only crisis you're gonna have.

(gentle ambient music) Usually coping is strengthened, just like a four-legged stool is more stable.

So a good four-legged stool is one that doesn't wobble.

So you want all four of those legs going down all the way to the floor.

One leg of that stool is activities of daily living, eating, sleeping, taking care of yourself, and taking care of yourself is sometimes the first leg of the stool that breaks off.

Another one of those is participation in a supportive community.

Now that's really important, because when you're struggling and ambivalent, you're often seeking information from people.

And if they're not supportive to what's going on with you, then it's gonna be hard for you to listen to them, and maybe their advice comes off glib or unhelpful.

(gentle ambient music) And also doing things that give your life meaning, the things that help you feel good about life, and people sometimes let go of things that they used to do on a regular basis, but those things they've quit doing were part of coping, and so we want them to have those back.

And the last leg of the stool is physical wellbeing.

When people are ignoring their physical health, it will affect all the rest of their health, as well.

So I do think that crisis theory and the four-legged stool are something everybody could learn to invest in.

If you've got a stool where one leg of it is broken two inches off, it's not stable.

You want all of the legs touching the floor evenly.

I don't want you to saw the other three legs off.

I want you to grow that leg back down to what it used to be.

We don't focus on coping.

I think we should be teaching coping skills beginning in the first grade, 'cause kids are gonna struggle with accepting loss all their life.

Why not teach them how to talk about that loss in a way that's congruent for them?

Coping is one way we can support them the rest of their life.

Now, all of us come to life with whatever we learn in life as our coping behaviors.

And suicide is a coping behavior.

It's maladaptive, because it doesn't help resolve the crisis, it creates a new crisis for those left behind, and that unfortunately is why the bereavement process for those who've lost someone to suicide is like a minefield.

It's full of things that can go wrong.

(gentle music) The term "survivor" can be confusing, people often think that means someone who attempted.

What we're saying is this is a survivor of a suicide loss.

This is someone whose loved one died by suicide.

- So my brother was, his name is Dominic Crespin, he worked in the news in Albuquerque, was a cameraman for over 25, 30 years almost.

We used to joke that he was like the unofficial Governor of New Mexico, 'cause everywhere he went, people would know him.

So it was an interesting relationship with me and my brother because we did, we were 11 years apart, he taught me songs and taught me games, and now granted, when we did live together, we fought all the time, like he was a true older brother.

For some reason, I think he said he saw it in a movie, he would have me, he would call it "Eat the floor", and would hold me down, and make me chew the carpet of all things.

Who does that?

My brother did that, but he was still such a good older brother to me, and more so though was just a really kind human being to so many people.

- Sarah was my younger sister.

She was my only sister.

We were four years apart.

She was my first best friend.

We moved around a lot when we were kids, so moving around so often, she was really my only constant in so much.

She was 20 when I lost her, so I really only have a perception of her as really a kid and a teenager.

We were just kind of rambunctious kids.

We were always stressing our parents out.

One of my favorites was building a mud pit in the backyard.

My mom was so upset, like so upset with us.

So it's been a decade now, or almost a decade.

There's not a single day that I don't think of like, "Oh, I wish I could text her and tell her about this."

Just the fact that she died so young, I feel like has informed pretty much anything I've done since then, just the idea of like, I feel like I'm kind of living for both of us in a way.

(gentle music) - It has taken my life and turned it upside down.

It's affected me since I was a child when I lost my uncle Jamie.

I was about seven-years-old, but to me, he was the fun uncle.

He was my best friend.

And then when I lost him, I blamed myself, because I didn't answer his phone call.

I eventually somewhat healed, I had some childhood trauma from that, and then when I lost my dad, it completely destroyed my life.

I felt guilty, I felt all the emotions, anger, and then again, two years later when it happened to my brother, I didn't know where to put the blame.

- The days directly after, everything was a blur, in a way that almost feels like it happened to like somebody else.

You couldn't focus on anything else, because I had to face the fact that my sister wasn't there.

Just everything felt very out-of-body, like it would be as soon as you start to choose something that feels normal, you remember like, "Oh, this entire part of my life is now missing, and this is permanent."

It changes, over time, you get used to it, you get a little more numb to it.

There are still moments that like hit me in the face that I'm like, "She's really not here."

- Most deaths have what we would call "a gentle deathbed gathering."

Loved ones can come, be with that person, they have a sense of pre-grief that their loved one's dying, especially with natural causes.

What you don't have with suicide is any of that.

You have sudden and traumatic loss.

- I wish everything could have just paused for just for a second, you know what I mean?

I mean, just everything just pause, and let me breathe, and let me sleep.

I was so tired, I think that was really hard for me was how exhausted I was.

- In the next 48 hours, you're supposed to plan a funeral, and get everybody you know into town, and also now you're responsible for the accommodations, and the logistics of it all, like that is wild to me.

You've got such a momentum from that, that I think, for me, that was all that I could focus on.

And I don't know if it was like conscious to me really at the time, but I put a lot into her funeral, and everything surrounding it, 'cause I was like, "I'm not gonna get anything else.

I don't get to plan a graduation, or a wedding, or a baby shower", like I had a conduit for all of my emotion that I could ignore what I was really feeling to focus on that, and then when it was gone, it was just like such an emotional overcorrection almost of, "Okay, now that I don't have anything to funnel this into, what am I gonna do with how I'm feeling?"

- Now you can have a sudden traumatic loss in a car accident, but it was an accident, and you know who was involved.

(gentle ambient music) - I don't wanna say it's a choice what they did, but it's different that that's the way they went out, so I lost my sister in a car accident, and I don't grieve her the same way that I grieved my brother.

- You know, hopefully more and more communities and folks are showing up, but it used to be that, you know, if someone died in a car accident, the casseroles all came, and people showed up and sat with you.

And for suicide loss survivors, it was more the silencing.

- When I lost my brother, it was hard, (gentle ambient music) but after losing my dad to the same thing, I knew how people would look at me and judge me.

And so at his funeral, I kind of knew what to expect, 'cause it was the same thing as my dad's.

- Now all of a sudden you're looking at "What was my role in this?

What did I do that facilitated their loved one's death?

Am I to blame?"

'Cause society looks at you like that.

People will come up to survivors at the funeral, and say, "What did you miss?"

They'll accuse them in that way at the funeral, or they'll say, "I'll pray for your loved one, 'cause I know they're burning in hell."

Some kind of condemnation in the afterlife that has been discarded years ago.

- "Because your sister chose this, like surely you'd known something, didn't you see something?"

They're just questions or attitudes that I think that with suicide loss would never enter the minds of people for any other loss.

You would never ask that, "Oh my God, how would your so-and-so not know that that car was coming?"

Like, but people feel comfortable asking that for suicide, like that'll never not blow my mind, and I feel like it is very, very different.

- You don't need to know how, or you don't need to know why.

You need to say, "I'm so sorry that your loved one died by suicide.

What can I do to support you?"

Because it's almost morbid curiosity people have.

Our society is just, still has a long way to go of the folks who are left from suicide loss not feeling like it's gonna be responded to differently, you know?

- I feel like nobody truly understands.

They all say just, I guess, stereotypical sayings about how "God gives the toughest battles to the strongest soldiers, it gets better, you must be super strong", and I feel like a lot of that was more hurtful and not helpful, because I don't feel strong for going through this.

- When someone loses someone to suicide, it's not only an internal and external crisis in their life, it becomes something they never had to cope with.

- At first, I did not take very well to the loss of my dad.

I self-destructed, I did not come out of our apartment, we went to his funeral, and then I stayed in our apartment.

I got diagnosed with major depressive disorder, and I got put on multiple different medications, because I could not shake out of my funk.

I struggled being there for my children, and being there for myself, and there were times I would go without showering, I would go without eating.

- You know, that's why veterans have such high rates of PTSD because things happen that they had no idea are about to happen, right?

And they can't control.

Suicide is very much like that, right?

You didn't, you know, for most survivors, they had no idea this was coming, and all of a sudden, they get a phone call, that they think like they're, "Oh hi, what are they getting?"

And all of a sudden they found out someone they love very, very dearly is all, is gone.

That's a huge, unexpected, huge traumatic event.

- So I was actually here at the theater, and I had missed some calls from my family, I saw a text from my sister said, "Hey, give us a call back.

Dominic's missing."

We started getting notifications from somebody that found the vehicle, and so we're all trying to get there as soon as possible.

So for some reason, I was like the central person.

Like I didn't go wandering, I didn't go looking, I stayed there to kind of help navigate things, I was the person, you know, talking to the police, and giving the reports, and things like that, and I was answering a call or something, and I heard the Pastor call for my nephew, so I kind of went that way and he came, and he said, " I didn't see anything, but I think there's something here, I think I saw something in this area."

So I sent the police on their way to that area, this wooded area, and they came back, and they were the ones that said, "Yep, I'm so sorry to tell you that that's your brother, and that he took his life."

And then I had to turn around, and tell my family.

That was hard.

My sister was there with my cousins, and I thought, "Okay, I need to let them know, but also contain it."

We knew that we needed to tell my sister-in-law, April, and my nephew, Reyes, and then we needed to tell my parents, before it got out.

(gentle music) - It sucks and there's just no way around it.

There's such a battery of emotions from like shutting down to full-fledged anger, and guilt, and just all of it, and none of it is wrong.

You're getting to know the ins and outs of that, just debilitating, all-consuming, this is everything right now, or pushing it off, and I think that as time has gone on, especially with avoidance of it, no matter how many times I react in that way, it always comes back in one way or another, I think in like the immediate years after my sister had passed, like I worked all the time, and that was such an easy distraction, just literally anything I could that wasn't dealing with the place I was at, and probably what I needed to deal with.

Once I was able to find a better balance in that instead of losing myself in it, just really being able to clear up, I think, the mental space and the excuses to just sit with some of the really uncomfortable stuff, like facing that harder, uglier stuff.

There's no way out but through, and I tried every possible way through until I really didn't have another choice.

(gentle music) - Far too often, we just are, there's like a, "Okay, they aren't embraced", or it's like, "Oh, you should go to therapy, you know?"

And it does elevate someone's risk themselves, so it's important that we wrap around them, not push them like, "Oh, you should go there" rather than, you know, embracing them, and saying, "What do you need now?"

And not being like, "Well, it's a relative who died.

They're not, you know", no, it really, really elevates the risk, because all of that flood of emotion and it's a sudden unexpected trauma.

- If I look at bereavement for suicide, suicide grief is the thing that happened.

What I know from my own research is about 30% of the people who come for help honestly report having thoughts of their own suicide, having never had those in their life prior to exposure with their loved one's death.

Shneidman's got a famous quote that I like to offer that "The deceased placed a psychological skeleton in the survivor, the person left behind, it put it in their emotional closet."

(gentle ambient music) (gentle guitar music) ♪ I saw the clouds ♪ rolling on a sunny day ♪ ♪ And somehow nothing could ♪ prepare me for the rain ♪ (gentle guitar music) ♪ Ooh ♪ ♪ I tried to justify all ♪ the pain in my heart ♪ ♪ Thinking I'd be fine ♪ ♪ If I could find someone to blame ♪ (gentle guitar music) ♪ For the way things are ♪ (gentle guitar music) ♪ No stars made to last ♪ ♪ And I know love is all we have ♪ ♪ To chase away the time ♪ ♪ Has been weighing on my heart ♪ (gentle guitar music) - I love you all.

I don't need a thing.

♪ And that's a sound ♪ (gentle guitar music fading)