Bridging the Gap: Interview with Author Jack Jordan

Reprinted with permission from the American Association of Suicidology's Surviving newsletter

Jack Jordan, co-author of Grief After Suicide (available on Amazon.com)

As I was pulling together my syllabus to teach a course on Suicidology to graduate level clinicians, I was searching for a text on suicide postvention when one arrived at my doorstep. Dr. Jack Jordan, a clinical psychologist from Pawtucket, Rhode Island, had sent a copy of the recently published book Grief After Suicide: Understanding the Consequences and Caring for the Survivors. Jack co-authored the book with Dr. John McIntosh and sent it to me for my review. After flipping through the pages, I was impressed with the depth and breadth of the book, and called him immediately to thank him and interview him about this work. The following conversation transpired on December 3, 2010.

Sally: Who is Jack Jordan?

Jack: I’m sort of an odd duck. I’m a clinical psychologist in private practice, but I also function like an academic. Twenty-five years ago, I became involved in the “Family Loss Project” – a group of practicing clinicians who were interested in the impact of loss on family systems, especially multigenerational impact.

Sally: How did you get into the work of studying grief among survivors of suicide loss?

Jack: Thirteen years ago, I had an epiphany. We were working with survivors of suicide loss in our practice and I thought, “They should be talking to each other.” So, we started a support group and it ran for about 13 years. To me, this was an inspiration. I saw their suffering, but I also saw their resilience and how they helped each other.

Sally: What came next?

Jack: I became involved with the American Foundation for Suicide Prevention and co-wrote the manual for their facilitator training program with Joanne Harpel. I took the training for the Suicide Prevention Resource Center’s Assessing and Managing Suicide Risk curriculum. Now I train and consult around the country and the world.

Sally: Has suicide touched you personally?

Jack: I am a distant suicide survivor – my great uncle took his life in 1987, but it was not a life-transforming loss because I only knew him in my childhood. It was my Dad’s death due to cancer when I was in my 20s that pulled me into grief work.

Sally: What is the inspiration for the book?

Jack: The book comes out of my interest in bridging the gap between research, academia, clinical work, and survivors. It has been apparent to me for a long time, somebody needs to do this; so finally I decided, maybe it’s me. I invited John [McIntosh] to work with me because he has researched and written about survivor issues for a long time.

Sally: What are the goals for the book?

Jack: Our target audience is really researchers and clinicians, and to a lesser extent activist survivors. This is not a self-help book; it’s really meant to say, “What has happened in the last 20 years in the field of survivor studies?”

Sally: Tell me about the book’s journey. What have been some of the challenges and celebrations?

Jack: I have gone from despair – was I actually going to survive this? – to some revelations. Everyone connected to you endures some of this. I pay homage to my wife for her patience. The revelation came because this work helped me see even more clearly how much is going on simultaneously around the world. Suicide awareness and prevention have been coming out of the closet. Now survivors are too. I hope the book accelerates this. All this amazing stuff. This work also helped me understand that despite some obvious cultural differences, the themes of survivor grief are similar around the world. I expected more differences, but at the heart of it all, losing someone to suicide transcends cultural difference.

I had a great partner in this. John loves to do the stuff I loathe. The APA references made me completely nuts. Thank God John could do this. My forte is about broad strategic thinking and writing.

Sally: What has happened since the book was published?

Jack: I went to a conference in October [2010] and had not seen a hard copy yet. There it was, and someone asked me, “Would you autograph these?” Strange experience. Surreal. I thought, “Oh, the cover came out pretty good. Maybe I’ll buy a copy.” Hopefully, the book will serve as a catalyst in the field, stimulating more research and clinical theory.

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For more resources for Survivors of Suicide Loss visit the American Association of Suicidology: click here.
 
The Carson J Spencer Foundation offers families recently bereaved by suicide iCare Packages (semi-customized resources packets). For more information: click here.


What are your thoughts on what is needed to support survivors of suicide loss?

How to Develop Mental Health Awareness Programs

I love dreaming up innovative and engaging suicide prevention and mental health promotion programs with students and communities. When I am with a group in the brainstorming phase of what is possible, I get really excited about cool programs that might reach people in new ways. When we generate our list of ideas, and narrow down on what we THINK might work, we then ask ourselves, how will these ideas fit into a comprehensive and sustainable approach?


Here are three key steps to developing a successful mental health program:

STEP #1: Develop a Circle of Evaluation – we all know that resources for mental health promotion are precious on our campuses and in our communities, so we must make sure we are maximizing positive change. In order to do this, we need to find ways to measure our outcomes along the way. Throughout the process of the program’s development and implementation we can figure out what is working and what’s not by:

• Conducting a needs and strengths assessment to determine where the gaps on our campuses are

• Piloting our campaign or program before we implement to make sure we are on the right track

• Measuring immediate impact beyond just “numbers of people who attended” – what are we hoping happens after people have been exposed to our program? For ideas look into best practices in program evaluation.

• Evaluating longer-term outcomes – what is the ultimate purpose of our programs and are we meeting those goals?



One effective tool to use when developing a mental health program is a LOGIC MODEL. This process helps you think through the above questions and how they link together.

STEP #2: Look at All Levels of Prevention

When I ask folks which groups we need to focus on when we develop our suicide prevention and mental health promotion programs, I inevitably hear “everyone!” While it’s true that everyone can potentially benefit from some piece of a larger mental health promotion effort, I find when you try to reach EVERYONE, you end up reaching no one. As you develop your mental health program consider these three levels of prevention:

• Primary prevention is designed to reach a whole community by promoting general strategies that we can all benefit from (e.g., knowing the Suicide Prevention Lifeline 1-800-273-8255)

• Secondary prevention is targeted at high risk groups such as people with pre-existing mental health conditions or LGBT students. These strategies look at minimizing risk factors and bolstering protective factors for these groups.

• Tertiary prevention strategies focus on individuals who are already distressed and are designed minimize the impact of mental illness or suicidal behavior (e.g., promoting mental health services or support groups).

STEP #3: Research Evidence-Based Practices

When you are developing your programs, you should consult the Best Practice Registry to get some guidance on where to start. Because there is so much emerging research in the fields of mental health promotion and suicide prevention, you may find there is little research in your specific area. If this is the case, you can also look at respected theories like Dr. Thomas Joiner’s Interpersonal Theory of Suicide or Dr. Patrick Corrigan’s work on stigma reduction to help guide your decisions. Be sure to also consult the safe messaging guidelines before you get too attached to an idea, because sometimes what we THINK helps people, actually can increase risk.

Resources for Next Steps

Please visit the following resources to research what we know works in suicide prevention:

http://www.sprc.org/
http://www.peoplepreventsuicide.org/

I have a draft of a mental health programming booklet – please email me (Sally@CarsonJSpencer.org) if you would like a copy.

Be creative! Be strategic! Have fun and let me know how it goes. If you want to share your programs with me, I would love to include them in the booklet.

For a more in-depth presentation of these topics, please listen to my podcast:

PODCAST



Man Up! Suicide Prevention and Men of Working Age Part I: Men at Risk

photo from Velvettangerine

• Suicide is the second leading cause of death for men 25-34 
• Males are four times more likely to die from suicide than females
• The majority of people who die by suicide in Colorado are white (non-Hispanic) men of working age   

Source: WISQARS, Centers for Disease Control

Gender role socialization theories offer a perspective that helps explain these statistics. Cultural codes of achievement, aggression, competitiveness, and emotional isolation are consistent with the masculine stereotype; depressive symptoms are not.  Cultural ideals of rugged individualism lead to social fragmentation and fewer coping alternatives.  In fact, when we look at gender roles a double jeopardy emerges.  That is, those men who are in the most need of psychological help are the least likely to use them.

            According to Mansfield, Addis and Mahalik (2003), when men consider seeking help, they often go through a series of internal questioning:

1)      Is my problem normal?  The degree to which men believe other men experience the same problem affects their decision to seek help.  A prime example of this psychological process is erectile dysfunction.  Before Senator Bob Doles’ public disclosure, many men thought they were the only ones suffering from this highly common and highly treatable problem.  After the public campaign, many more men sought help.

2)      Is my problem central to who I am?  If the mental health symptoms reflect an important quality about the person (for example the hypomania in bipolar disorder that impacts creativity or productivity), then the person will be less likely to seek help.

3)      Will others approve of my help-seeking?  If others, especially other men, are supportive, then the person will be more likely to go.  Help-seeking is particularly likely if the group is important to the person and unanimous in their support.

4)      What will I lose if I ask for help?  For many the biggest obstacle for asking for help is fears losing control: losing work privileges or status, being “locked up,” or losing one’s friends or family.

5)      Will I be able to reciprocate?  Usually, the mental health services offered do not allow opportunities for reciprocity.  Because of ethical standards, the mental health practitioner is often not allowed to share personal information or receive favors, thus maintaining a position of power over the client.  For some men, receiving help is acceptable only if they can return the favor later on; in the relationship with a mental health provider, this is often not possible.  One exception is Alcoholics Anonymous (AA).  According to their mission, “Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.” According to the AA fact file, men make up 65 percent of membership in AA, indicating that this model of reciprocity is appealing to men. By contrast, among persons with any recent mental health disorder, a higher percentage of women (16%-26%) made mental health visits than men (9%-15%).

Thus, as we begin to this of how to reach men at risk, we need consider alternative ways to reach those who might be the least likely to seek help. This requires a paradigm shift on our part. Stay tuned to the second part of this series to learn more.

What are your thoughts on men and help-seeking?

The Gift of Secrets

As we find ourselves in the season of gift giving, I recalled a great lesson I learned from a man with a simple but profound idea.


“We keep our secrets in a box. Sometimes we bury them deep like a coffin. Sometimes they are like a gift that we open up and share with others,” Frank Warren, founder of PostSecret, said to a packed audience of college students who participated in this year’s Active Minds Annual Conference in New Jersey.

Frank Warren at Active Minds Conference

As a mental health speaker, I love to hear other speakers share their ideas on how to help people thrive. I was especially transfixed by Frank Warren, America’s most trusted stranger, talk about the power of secrets in our lives. Frank started with a simple idea: letting people unburden themselves of their secrets by encouraging all to send their anonymous secrets to him on postcards. What has evolved over the years is a compelling project with a strong suicide prevention message.

Frank has had secrets mailed to him on sea shells, a potato, even a death certificate. Of the millions of secrets he has received from all over the world, he has learned a few things about what we hide about ourselves and how we are very curious to know these potent pieces of information about each other.

“At the center of these secrets there is a kernel of wisdom we can grow from,” Warren states. “When we think we are carrying a secret, sometimes it is actually carrying us. Blocking us from what we might otherwise be.”

Frank has learned one of the important tenets of my resiliency talks – sharing our personal struggles helps us to create intimacy and community with others. When we go beyond “the mask” we wear each day, we create a deeper channel of knowing and a stronger bond. This sense of belonging can help us withstand future challenges we might face. Frank closes his talks by training students on some basic suicide prevention skills: ask the direct question “are you thinking about suicide?” and know your resources for mental health help, like the 1-800-273-8255 Suicide Prevention Lifeline.

Frank has also witnessed how we can overcome our brokenness and become more resilient by rising above our hardships in live, “the children almost broken by the world become the adults most likely to change it tomorrow.”

Thank you, Frank, for a wonderful example of how a simple idea can move the world to action.

What are your thoughts on the power of secrets?

Social Entrepreneurship Part II Working Minds for Youth: Social Enterprise for Suicide Prevention

The other night our high school social entrepreneurs were amazing. After serving them pizza, we gave them a 20-minute challenge: to work together to develop a t-shirt or mural idea that would help prevent suicide in their community. We mixed students from different schools into small groups, gave them pens and paper and let them go.

Social enterprise students brainstorming ideas for suicide prevention

Now these students aren’t new to the ideas of suicide prevention or social enterprise. They have been working with the Carson J Spencer Foundation and Junior Achievement since September to gain mastery in both areas and have been thinking about how the two missions might best work together. Every week for at least an hour they receive coaching on business skills like marketing, finances, and product development and on suicide prevention skills like how to be a suicide prevention gatekeeper, how to conduct a needs analysis and how to promote safe messages to increase awareness. They are a passionate, dedicated crew.

The challenge this week was just a warm up, and you can see some of their excitement and creative ideas by viewing this 3-minute video montage.

In February each school participating in this project will have developed a viable business plan for a social enterprise for suicide prevention. In other words, they will have dreamt up a sustainable product or service that will raise money and create a positive change for this life-saving cause. They will then pitch their ideas before the Carson J Spencer Foundation’s Board of Directors, competing for seed money to launch their business. Winners will go on to use the money to implement their plans during the spring semester. At the end of this second semester another round of competition will take place – this time the winners will be rated on both the financial profit and the social profit earned through their work. They will be rated on: innovation, effectiveness, sustainability, and revenue.

Green Mountain High School students cheering after winning business plan competition

I love this project because it just works on so many levels. By partnering with Junior Achievement, we are engaging a new audience for suicide prevention: our future business leaders. Students are passionate about suicide prevention because even at their young ages, many of them have already been touched in some way – either their own mental health crisis, or someone they love. The project is also just plain cool. Social enterprise is a great new trend – a creative blend of the efficiency of the business sector with a heartfelt mission of the non-profit sector. Students are empowered to use their creativity and be leaders in their community. Win, win, win.

Check back in February to see how they did…

Social Entrepreneurship Part I: Using Business Skills to Solve Social Ills

Recently, I joined a group of social entrepreneurs sitting around a crowded table at the Women’s Bean Project headquarters in Denver for a historic moment in the social enterprise movement: the group voted to launch a Colorado chapter of the Social Enterprise Alliance. As someone who has championed social entrepreneurship education among our young people for the past five years, this is great news. Together, we can forge the power of a coalition to increase the capacity of social enterprise initiatives around the state and to expand public consciousness, embracing and promoting these cutting edge ideas.

Lisa Nitze, President & CEO of Social Enterprise Alliance charges the group to dream big
as we launch our Colorado chapter.


What is Social Entrepreneurship?

In his documentary series on social entrepreneurs called The New Heroes, Robert Redford described social enterprise as “Applying business skills to resolving social ills…part saint, part politician, part business person.”

While an entrepreneur thinks in terms of results and profits, a social entrepreneur seeks results that will change people’s lives simply, quickly, and profoundly. Social entrepreneurs use innovation and strategic partnerships to address root causes of social problems ranging from poverty to pollution, from mental illness to youth-at-risk. The “social profit” of a social entrepreneur is sustainable human and economic development.

Social entrepreneurs conduct gap analyses in their communities – looking to address needs and build on strengths. They look to seize an idea that fills a unique niche and has potential for scalability. And just like in the business world, social entrepreneurship is linked with risk. Social entrepreneurs are courageous, unconventional and able to see new opportunities when others see nothing but hopelessness.

When contrasted to charity, social enterprises don’t rely entirely on community support for their own sustainability; social enterprises work to generate the earned revenue needed to keep their operation going. Social enterprises also don’t just serve immediate needs, like food and shelter, without addressing the underlying causes perpetuating these needs. Social entrepreneurs view the marginalized as the solution not as a passive beneficiary. The social enterprises they build begin with the assumption of competence and resources in communities they are serving.

In the words of Bill Drayton, CEO, chair and founder of Ashoka, “Social entrepreneurs are not content just to give a fish or teach how to fish. They will not rest until they have revolutionized the fishing industry.”

I got interested in social enterprise while I was getting my Masters in Nonprofit Management a few years ago. My instructor and founder of Triple Bottom Line Partners, Nancy Fell, inspired me to apply these concepts to the work of the Carson J Spencer Foundation (CJSF) and the leadership development courses I was teaching at the time. In 2007, CJSF won a business plan competition for our gift basket enterprise that tied into our work promoting mental health, but we found it was too labor intensive for our human resource capacity. Today, this gift basket concept has evolved to what we call “iCare packages”: books, comforting music, and other resources we attractively package and send to families recently bereaved by suicide. We have solved our human resource problem by forging strategic partnerships to assist with the distribution. From 2006-2009, I taught a sophomore seminar that challenged the students to create social enterprises for suicide prevention, and most rated this activity the most useful learning of the whole course. Today, CJSF works with high school youth through a program we call "Working Minds for Youth" to expand these ideas and support the development of the next generation of socially entrepreneurial suicide prevention advocates – stay tuned…

Next blog:

Social Entrepreneurship Part II: Working Minds for Youth – Raising Money and Awareness for Suicide Prevention

How have you seen social enterprises impact communities?

Spirituality and Suicide Bereavement Part II: Spiritual Signs from Loved Ones

Because I have walked the path with many survivors of suicide loss, I know that there is something survivors talk about all the time that is rarely, if ever, explored in scholarly publications, so I will open the door in the context of discovery here in the hopes that others will find ways to further its research. What I am referring to are the signs that many of us experience in the aftermath of our loved one’s death that in every cell of our bodies feels like a communication from our loved ones. On the eve of 6th anniversary of Carson's death, I share some of my experiences in the hopes of connecting those in the survivor community who have also experienced the unexplainable. I also hope that this sparks a conversation among those interested in suicide bereavement that leads the field of suicidology into further research on this topic.

During the first six months after Carson’s death, I had several spiritual experiences that to me felt like nothing I had ever experienced before. While I can believe, that perhaps these were the manifestations of a traumatized brain, I also hold open the possibility that they were more than that. While all of the experiences played important roles in my healing journey, I will share with you the last and most profound one – his “goodbye visit” to me while I was on my second honeymoon in Hawaii.

It was only six months after Carson’s suicide when my husband Randy and I gently opened the spring-loaded door that swung back upon us and entered this place of dreams: an old cottage on the beaches of Kauai. Bang, bang, bang the door retorted behind us as we eased onto the wise, creaky floors that carried the footsteps of history before us. This cozy plantation home had been relocated from the sugar fields of Kauai to its new resting place on the sometimes sandy, sometimes grassy Hawaiian shore near Wimaya Canyon. Its musty scent held the mystery of sun and sea as we tenderly placed our bags upon its well-worn wooden floor and set off to explore. On the back porch, the salty breeze was laced with the celebratory, syrupy scent of flowers just past their prime, and we slid into the oversized Adirondack chairs that engulfed us and whispered gently, “relax.” When started planning this trip to celebrate our 10-year anniversary well before my brother’s death, this was exactly what I had imagined. We leaned into the place, longing for the warmth of the sun, and delighting in the hoppy and deep-fried air wafting from the brewpub behind us, “Ah, peace.”

That night as we went to bed, the muffled murmurs of the other tourists returning from big adventures drew closer and then farther away as their sandals crunched the gravel of the path past our cottage to theirs. As I drifted off to sleep, Randy’s deep breathing rose like the comforting sweet steam from a home-cooked stew and lulled me into a vivid dream state.

In the dream Carson appears before me and I am once again instantly struck with a sucking feeling just below my sternum that radiates both terror and awe to my extremities like an electric shock. He is an adult this time, dressed simply in a “red dirt t-shirt” and jeans. The red dirt t-shirts were a touristy souvenir of the region where we were staying, dyed from the red tinted earth on the Wimaya land, so I knew this was his way of telling me he was here with me. His face expressed gently worn nuances of eyes that knew more and were both sad and reassuring and a mouth that raised tentatively on the edges. We found ourselves at the swimming pool that was built between the cottages and the ocean. On the day Randy and I had arrived at the plantation cottages, the water in this pool had been too cold to swim. In the dream the water was soothing and perfectly tepid. Carson approached this simple rectangular in-ground pool with blue water and wide edging, and slowly walked down its steps toward me. We met in the middle of the pool and he gave me an engulfing hug. In slow-motion, we sank into the viscous liquid, deeper and deeper as if being pulled by an anchor to the bottom of the pool. Then, thud. We landed on the gritty pool floor.

“This is the last time,” he whispered.

I felt his large, powerful body start to dissolve in my arms.

“No, no, no, no, no!” I screamed until I could feel him no more. And I woke up with a startle and the strange but familiar cocktail of fear and rage burning like acid in my esophagus. My thoughts were racing, “this may be the last visit in a plantation cottage in Kauai, but not the last time you will visit me!”

I bolted out of bed and shuffled my way through the darkness to the bathroom, where the grounding coolness of porcelain tile, started to erode my agitated state. I sat there, my head on the toilet cover, heart slowly returning to my chest, and relayed my latest dream to my husband who, as usual, listened politely, without comment.

The next day was our final day in this magical place, and we had decided to take a cruise around part of the island, but our boat did not leave the dock until much later that afternoon, so we decided to walk around the touristy shops of the town. And of course, we quickly ran into a store called the “Red Dirt T-Shirt Shop.”

I turned to Randy, “Let’s go in.”

On one level I was thinking I needed to get just one more present for our littlest boy, Jackson. I had bought our other two sons little Hawaiian shirts, but I had not found one small enough for our 8-month old. On another level, I was hoping for one more mystery to emerge. I turned to the back rack and flipped through the options until I found what I was looking for, and then I headed to the counter.

I stood in line behind a woman who was speaking with the clerk behind the counter loud enough for me to hear. She spoke of the clerk’s daughter who apparently had just died, and of the doctor who had taken his life, apparently out of remorse for not saving the girl.

Then it was my turn at the counter.

Before I had even put my purchase up, and with a line of people behind me, I said, “I had a dream last night. My brother who died by suicide was in it wearing a red dirt t-shirt, and now I am here, I just overheard your conversation, and I think I am supposed to talk to you.”

Without missing a beat she said, “Your brother is fine.”

I felt the air releasing from my lungs, like a balloon that has been untied.

“The man I was just speaking about…the doctor….He also visited me in my dreams after my daughter died, asking for my forgiveness. And I said, of course.”

I thanked her, paid for my little Hawaiian suit and as I walked out the door, I turned to Randy and said, “See! I just can’t make this stuff up!”

Since that dream, I have not had the same intensity of what I believe to be a connection with Carson. What those experiences gave me, however, was a belief that there is more than we can understand in the spiritual realm while we are in our current existence. I believe that my brother was doing his best to ask for forgiveness and say the goodbyes that he didn’t get to in life. I am reassured that his spirit is okay, that his soul has moved on to other things, and that I will be seeing him again when my life is over. Before my brother died, I did not have a spiritual framework that supported these beliefs, but now I do. This was his gift to me. Because of these experiences, I find myself talking to him often – asking him for clarity and courage, like others might talk to God. Like many others, I am learning to develop a new relationship with my loved one. He isn’t gone, our relationship has just changed.

For those of you bereaved by suicide – have you received signs from your loved ones? Please, share your stories here.