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Ask The Experts

Worried About a Friend

Worried_about_a_friend_2014

A friend of my close friend died by suicide. Since that day my friend’s been very depressed. He’s been skipping class and not getting out of bed. I’m starting to worry about him. When is it time to say something to him?

Morton Silverman, M.D., Senior Advisor, The Jed Foundation and Suicide Prevention Resource Center answers:

You ask a very important question which is not easy to answer, because we all grieve in different ways and for different lengths of time. I am glad that you are aware of the changes that you have noticed in your friend. This will serve you well when you point out specifically to him why you are concerned about his behavior, and will serve as benchmarks to monitor change and improvement over time.

First of all the grief process can last for months, and sometimes up to a year or more. We believe that there are definable stages that are part of the process of recovery from bereavement, although there is no single path to follow in order to get through them all. Sometimes it occurs that an individual will return to a prior stage that was thought to be successfully resolved – only to have to confront those feelings and thoughts all over again. In and of itself grief is a natural and expected process. You might reassure your friend that what he is going through is normal and to be expected. Being patient may be difficult and wondering when he will turn the corner may be worrisome at times, but as long as he is making progress your major role is to be understanding and supportive.

It is difficult for any of us to grieve the loss of a close friend. It is even more difficult for adolescents to manage their reactions when a friend or a loved one dies, in part because they often have not had any prior experiences with death, grief, and the bereavement process. So they don’t come equipped to deal with the flood of emotions and reactions, and with mourning a significant loss. Furthermore death by suicide also leaves additional challenges and unanswered questions for the survivors. Should I have seen it coming? Should I have done more? Should I have left him/her alone? How similar or different is his/her situation from mine? Am I better able to cope with similar situations? So survivors of suicide are often struggle with feelings of depression, loss, anger, guilt, resentment, hurt feelings, as well as many more thoughts and feelings that they may have never experienced in the past – or had difficulty managing in the past. As a consequence meals are skipped, sleep becomes erratic, irritability appears, thinking processes slow down, fatigue sets in, prior interests and activities are avoided, and sadness abounds.

During the first few weeks after such a tragedy you can expect great swings in mood and affect. Sleep may be erratic and a lack of interest in usual daily activities may be evident. However, if the withdrawal and lack of activity continues beyond a few weeks you might consider contacting your primary care physician for advice. Weight loss, insomnia, and lack of attention to one’s personal hygiene (showers, combing hair, shaving, dressing neatly and in clean clothes, etc.) are indications that the grief process may have been halted, and interventions are needed to get him back on track.

Remaining predominantly preoccupied beyond a few weeks with death and dying, or suicide in particular, are warning signs that your friend is having difficulty with the grieving process and may benefit from a consultation with a mental health professional. Monitoring his concentration as evidenced by his schoolwork would be helpful as a measure of improvement over time.

Your friends might all benefit from the opportunity to share their feelings with each other and to learn how others have coped with similar situations. A number of resources exist on the web, starting with SPAN USA, a national organization of survivors of suicide. Other organizations, such as the American Association for Suicide Prevention and the American Foundation for Suicide Prevention have material available for you and your son to learn more about the aftermaths of such a loss. I would suggest that you contact the counseling office at his school to discuss how you can work together to help your son return to his prior activities. You might also approach your religious leader for support and intervention.