The Behavioral Corner

Hi, and welcome. I'm Steve Martorano. And this is the Behavioral Corner; you're invited to hang with us, as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while.

Steve Martorano 

Hi, everybody, and welcome to the Behavioral Corner. It's me again, Steve Martorano, I'm hanging in hopes that I run into interesting people -- and I always do. The Behavioral Corner is underwritten by our great partners Retreat Behavioral Health. Those of you who've caught up to the podcast, understand that we have a very laid back, and kind of familiar way of doing these things. And we're going to certainly keep doing that today. But in the interest of full disclosure, we got a somber kind of topic for you today. Something that, you know, sooner or later, we're all gonna have to deal with and that's grief, and how to handle it. In general, grief is a human experience at some point or another we'll go through. We're going to take a specific look at a specific kind of grief. Because it turns out that while it's true, we all grieve, in our own ways, not all grief is the same. In particular, we're talking about the grief associated when you lose someone to death by suicide. It is so deep and so hurtful that experts in the field talk about grief associated with suicide as a complicated grief. And in my reading about it that's what I certainly found old. We're very fortunate that we have a woman with us today who knows a lot about what I'm talking about, in a very tragic sense. But she's graciously and heroically agreed to talk about this. This is not the first place that she has spoken about her relationship to surviving suicides in her life. But we're grateful to Sarah Tinsley Puma, for joining us to talk about this very, very difficult topic.

Sarah Tinsley Puma 

Thank you for inviting me. I'm happy to be here.

Steve Martorano 

So let's begin with the particulars here and get right to it. Your experience with loved ones dying by suicide is pronounced. You lost your mom and your husband to suicide.

Sarah Tinsley Puma 

Correct.

Steve Martorano 

How recently did those two deaths occur?

Sarah Tinsley Puma 

I lost my husband a little over a year ago. And my mom was in 2018. So about three years ago, so pretty, pretty close together, and relatively recently.

Steve Martorano 

Okay, well, clearly, that's, you know, horrible circumstances. You certainly have our condolences. You're a working mom with a three-year-old daughter. Before we get to the sort of deepness of grief associated with something like this, can we find out a little bit about your mother and your husband? Specifically, where either or both of them suffering from mental health or physical conditions that might have had something to do with their death by suicide?

Sarah Tinsley Puma 

Yeah, they both definitely did. My husband was a Marine for 16 and a half years. He was -- he got out of the Marine Corps in...like two years before he passed. So he was kind of new to civilian life. He served three tours in Iraq and Afghanistan. So he definitely was not a stranger to the combat side of all of the wars that we've been involved in. And that definitely affected him a lot. He didn't really speak about it a lot. So I can't...I can't really say exactly what was going through his mind with all of that, but I know that it definitely affected him I could just see by certain behaviors and his reactions to things. Just like you would expect, like noises and whatnot.

Steve Martorano 

He was ever diagnosis, suffering from PTSD or anything like that.

Sarah Tinsley Puma 

He was and also had different anxiety disorders as well. However, I'm actually having trouble with the VA. They're trying to say that it wasn't connected to...his suicide wasn't connected to his...his service.

Steve Martorano 

Really?

Sarah Tinsley Puma 

That's kind of a process. That's a different subject. But...so yeah, that definitely played a big part in it. And he, you know, he dealt with the trauma and everything that he had been through and experiences. He dealt with them the way a lot of service members and veterans do through self-medication and different things. But, um, yeah, so that...that, you know, is kind of a whole conglomeration of...of all of that. But I think, you know, contributed to his very sudden decision to do that. My mother also definitely had some issues, she had a very traumatic childhood. She was basically shipped around. Mom didn't want her. Just...just really, really terrible childhood, and she grew up to be an outstanding successful woman. But she didn't really seek the treatment that I think she should have. And I think that just kind of caught up to her. And it's so important to seek help and just get, you know, therapy should not be a taboo thing. It's amazing what it can do for you.

Steve Martorano 

It's also amazing that we still have these stigma attached to certain things, no more stigmatizing events than someone who dies by suicide. It's almost sort of something one doesn't talk about, which, of course, doesn't help anything. Was this the first time that either they attempted suicide? Or Had there been other situations?

Sarah Tinsley Puma 

Yeah, my mother attempted a few times. Quite a few times. And she, you know, she was finally successful. But yeah, she, I don't want to say it wasn't a surprise but I think such... And my husband, he was a very interesting man. He was brilliant. He was...he was...his IQ was off the charts. He was very interested in figuring out what was, you know, in the ethereal and he would talk about that. Like, if I were to die this and cause that he would kind of just toy with the idea, and I never really, you know, thought it would actually happen. But yeah, you can see the signs now. Like, it's one of those hindsight things.

Steve Martorano 

Yeah, yeah. Well, I want to get into some of that, the aftermath of that sort of thinking, I just wanted to sort of get their situation before they died in my head, right. I don't mean to say that your mom's death by suicide was sort of inevitable or unexpected, but it seems different than what happened with your husband. What was the same about both of them, and that they are gone, and you still are here, and your child and you are the ones that have to deal with what I said at the beginning, is referred to as complicated grief? So Sarah, tell me, I understand that to mean, complicated in the sense that more than one emotion is involved when grieving for someone who has died by suicide. Can you tell us about some of those emotions? I've heard many times, that one of the things that come up is anger. You're actually angry at the person who is taking their life. Did you go through that?

Sarah Tinsley Puma 

Absolutely. I mean, it's...it's...it's an anger that is not comparable to any other anger, it's frustration and a lot of it abandonment...feelings. And you're angry because of the people who should be there? Well, in my case, you know, the people who should be there -- the closest two people in my life, aside from my daughter, she should be there to see her grow and everything. So that's...that's...it's very bothersome that they've chosen not to be part of that.

Steve Martorano 

Yeah, it's as though, something was done to "you," the person grieving. This is sort of an assault on "me." Which of course, you know, it's hardly...hardly the case -- I mean it's the case in one sense, but it's certainly not, you know, no one, I don't believe anybody sets out to hurt their loved ones. I think it probably is such a dark place that it doesn't even consider that concern that. What about you, but there must be great confusion involved in this? Did you go through all the questioning?

Sarah Tinsley Puma 

Yeah, absolutely. Um, I mean, I...you can come up with deductions from, you know, people's lives and why they might have done what they did. And I know that a lot of people who do die by suicide, they, they leave notes, or they, you know, explain something or they put a Facebook post up -- which is just tragic -- but we didn't receive anything from either of my husband or mom, so I can really only go by my kind of what I can think of, but ultimately, it doesn't change anything. If I knew the exact reason then it still wouldn't change anything and it wouldn't...and it wouldn't fix anything either. The only thing you really can do is try to move forward and honor their existence and continue to do your best in your life. But yeah, it does sit in the back of your, in the back of your mind, and it feels very personal.

Steve Martorano 

That...yeah, as it happened, it happened to you.

Sarah Tinsley Puma 

Right. Exactly. But you know, and it didn't just happen to me, you know, you can't just take it all, and you need to understand that other people are grieving as well. And I've made it a very, very, I made it a point to make sure that people know that. I know that it's not just all about me if that makes sense. Because even people that he knew when he was 10, and my mom knew when she was 10, they're still grieving, you know, it's, it's...

Steve Martorano 

In addition to all...of all of those very understandable emotions swirling around. I've read that many survivors like yourself, also feel guilty. They also think, did I do enough? Could I...could I have stopped this? Did you go through that as well?

Sarah Tinsley Puma 

Absolutely. Well, everyone grieves differently. I'll...I'll say that I've had my fair share of people express...you know, when something like this happens, people want an answer. And people in grief are...they do things that they don't normally do. And I've heard...I've heard words from people that, you know, they...they're just very angry. And they...they want something to blame. And that's not fun, but I get it. Unfortunately, with you know with my...with my husband, it wasn't my first rodeo. So I already kind of...everyone's different, every single grief is different, you know.

Steve Martorano 

Are you able to resist? I don't know if I can phrase this and have it make sense. Are you able to observe what's happening to you and, and kind of detach? Do you know what I mean by look at it and go, "Okay, I'm feeling this way...and I know why I'm feeling this way?" Or is it just so overwhelming that it begins to define you? Are you able to get some distance on the grief?

Sarah Tinsley Puma 

I am, and that's, you know, thanks to therapy, and just I educated myself a lot on coping mechanisms and whatnot. But yeah, like, it is...it is so important to be able to kind of examine the situation. I mean, life does go on, and I have definitely been consumed. I've been consumed by grief, but it is, it is absolutely important to try to remove yourself and look at things in a broader sense because otherwise, you will just you'll, it's a rabbit hole, and you'll keep digging, you'll keep digging. And the further your day, the harder it is to get out.

Steve Martorano 

I want to talk to you about the coping mechanisms for sure. And also what form of support you saw a minute but this notion, you said the phrase, "life goes on." You know, that's a cliche, but all cliches are true. That's how they become cliche. So life goes on. In this context takes on it would seem to be an incredibly strange quality, insofar as you're feeling unbelievable pain, I'm imagining, and yet, life goes on, right?

Sarah Tinsley Puma 

Yeah.

Steve Martorano 

Is there a need to reconcile those two things or just accept it? And try to move beyond it? How could life go on you know,

Sarah Tinsley Puma 

Yeah, it's a day-by-day thing. Today, I say life goes on. And I'm like, "Yes." I'm focusing on the positive and have goals. But, you know, tomorrow could be a completely different day, but I'm a pretty practical matter of fact, person. And the truth is, you know, tomorrow, this needs to happen. And on Monday, this needs to happen. We need to figure out a way to make that happen. And covering up your grief -- I've literally tried everything. I've tried everything. Okay, so if I just don't talk about it. Let's see that if I don't - (I'm) not reminded of it but... (That's) very unhealthy compartmentalization basically, of everything. Just basically, what I've learned and it's working for me, pretty recently, honestly, is just embrace your feelings. Embrace the feelings that are really bad. Live through them. Breathe them. Feel them. And then move on and continue to do your best, the person who you're grieving would want to see.

Steve Martorano 

Yeah, one day at a time never made more sense than in the context you've just described. Your daughter must be a tremendous blessing for you. You can focus on your grief in the knowledge that she needs you to be a functioning adult. I mean, it's been painful, of course, but it's got to be a big, big help. What professional help or support groups did you reach out for that you found helpful?

Sarah Tinsley Puma 

I have little support groups just on Facebook, or like closed private groups, I have.

Steve Martorano 

Is it helpful to be around other people who, who understand what you're going through?

Sarah Tinsley Puma 

Absolutely. I am a part of quite a few different groups, and I ended up finding some, you know, widows in my very remote area that are widows for the same reason. And when we meet up, it's like, our energies just mesh, because, like, it's understanding that nobody else understands, you know. It's...an even if you're, you know...you're...you're one side of the political spectrum and this person or...or anything, it's like, you have this in common -- and that commonality is the most strengthening things. So you do not feel alone in your, in your specific grief. Because I've had...I've had a lot of people, you know, tell me, "Oh, you know, I'm going through a divorce, I kind of, I feel your pain." By the way, that's one thing, don't say.

Steve Martorano 

Right, right, right. There's a list incidentally, for anybody that wants to know, there are lists out there of what not to say, to people in this situation. And one of the obvious ones, "I know what you're going through" is...is ridiculous. But people listen, let me ask you about that. You get you to get support. With people who've been there done that, which is understandable. But overwhelmingly, you are being supported by friends and family who do not -- who are friends anyway -- who are trying to be helpful. Is it difficult talking to them about this? Or...or is that awkwardness going away?

Sarah Tinsley Puma 

Um, I would say more than anything, because it's so taboo, people do not talk about it. People don't know what to say. So they don't even bring it up. That's the common thing that I found over the last, you know, three or four years is people -- they don't know what to say -- so they don't say anything and I think that if you don't know what to say, say, "I don't know what to say." Like, just instead of pretending like it's not a thing. Some people when they mentioned my husband's name, or my mom's name, me, immediately apologize.

Steve Martorano 

Right like they made a mistake.

Sarah Tinsley Puma 

Yes, I like "No! these people existed!" They were humans, they were a huge part of my life. I didn't forget about them, I don't want to forget about them. I want to cherish the beautiful memories we did have together. So don't say their name, you know, say their name.

Steve Martorano 

There's a sense that bringing up someone's death by suicide to the survivor. There's a shame attached to the act, which is really, really ridiculous. But that awkwardness is troublesome. I mean, but again, plenty of places, we go look and see how you're supposed to do this. I'm doing my stumbling best with some of the mistakes. Back to this notion of the why question, everything I've read many things I've read about survivors of suicide, it comes down to this "why." Why did they do this? Why? Why did they take their own lives? And I wonder if you struggle with the why question and whether you think there is any benefit in asking that question.

Sarah Tinsley Puma 

Mm-hmm. I absolutely struggle with that question. It's just a natural curiosity that you want to be filled. However, I recognize that that is not going to bring them back and it's not going to fix anything. So while I will not put a ton of attention or energy towards that, there's I just naturally will always wonder, but you know, I've just kind of chosen to understand that it was their time to leave and where were they went or you know, there's a ton of different thoughts on where people go that you that and whatnot. And why they do it. But it ultimately it doesn't change anything. So gratitude is one 100% what I've chosen to focus on, I am grateful that I had the time that I did with them. And if I falter away from that, or just even move away from that just a little, then that's when it becomes basically unbearable. So instead of the "why" I focus on gratitude, that makes sense.

Steve Martorano 

Yeah, it does make sense. Sarah Tinsley Puma, thank you so much. We are also grateful for the time you've given us. I wish you nothing but the best going forward. Very difficult stuff. You know, some folks -- all of us -- are going to get a certain amount of heartache that we have to deal with. Some get more than their share. I think that's the case here. But listen, good luck with the VA and your husband. Keep us posted on that. If there's anything that we can do in our small way to help you get them off the dime, please let us know.

Sarah Tinsley Puma 

Thank you, Steve.

Steve Martorano 

Wish you the best. Thank you so much.

Sarah Tinsley Puma 

Thank you. You have a good day.

Retreat Behavioral Health 

Retreat Behavioral Health has proudly been serving the community for over 10 years. Here at Retreat, we believe in the power of connection and quality care. We offer a comprehensive holistic and compassionate treatment from industry-leading experts. Call 855-802-6600 or visit us at www.RetreatBehavioralHealth.com to begin your journey today.

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