Monday Morning Crisis Quarterback

Lance Corporal Joshua M. Bernard, 21, died in Afghanistan on August 14. An Associated Press photographer embedded with his unit captured a picture of him after he was wounded and before he was transferred to a medical facility, where he died. This week Defense Secretary Robert Gates blasted the AP for publishing the picture, against the express wishes of Bernard's family.

On Friday, my niece's high school notified parents of the death of one of her classmates. Support was offered to students and guidance offered to parents, but no information was shared about the cause of death. The local newspaper reported it was a suicide.

These two events may not seem to have much in common, but in fact they capture a very common problem in traumatic situations. What happens when the powers that be, or just some random witness, have information about a death that the family does not want to share?

There are always two sides to this argument. In the case of Lance Cpl. Bernard, the AP argues that publishing the picture helps the public understand what war is really about. It says it is,

choosing after a period of reflection to make public an image that conveys the grimness of war and the sacrifice of young men and women fighting it.

Bernard's family, on the other hand, feels that the publication of the photo inflicts more pain on a family already traumatized and grieving. They prefer not to remember their son that way, and do not want others to see him that way. His father says the photo is disrespectful of his memory.

In cases of suicide, families often want to withhold the fact that their loved one killed themselves. There is a tremendous stigma in our society about suicide. Families often refuse to accept that the victim's death was, indeed, a suicide. Even if they do accept it, they fear that others will look down on them as the family, or will think ill of the dead family member who completed the suicide. It is not at all uncommon for families of those who complete suicide to hear from people trying to be "helpful" that their loved one was selfish or is going to Hell. Not surprisingly, families opt to limit the number of people who have cause to be "helpful" in this way.

On the other hand, from a high school administration point of view (and just generally from a public health point of view), it is important to talk about suicide. While no one wants to destigmatize it to the point where it is considered completely normal and acceptable, community leaders do want to get people talking about the depression and desperation that leads to suicide. The stigma surrounding suicide can prevent those who are contemplating killing themselves from getting the help they need, because they fear people's reactions if they talk about it. In a school setting, often the students know a classmate has completed a suicide, even when the administration does not acknowledge it. Not talking about it when everyone knows about it further sends the message that help is not available, and can lead to the clustering of suicides at high schools that sometimes occurs.

So, what to do? How do you weigh the educational and/or news value of a picture or a piece of information against the legitimate needs of a family in crisis? Whose needs for mitigating critical incident stress win? And whose values should we base that decision on?

We have a strong custom in this society of respecting the wishes of families of the dead. Because of this, violating those wishes provides an easy target for the natural anger that families feel after a traumatic death. I can't say that the AP made the right choice in the death of Lance Cpl. Bernard, even if I wish the family had given permission. They didn't. And I am not convinced that the picture had so much value that it should eclipse those wishes. Luckily, I don't have to make judgements like that most of the time.

As a school administrator and crisis team member, I will not disclose that a death was a suicide without family permission. But I will do two things to try to get around this. The first is that I will explain why I think it is important to share the information. Very often families are willing to hear that their disclosure may help another suicidal person, but they do not make that connection alone. School staff are also often reluctant to share this information, even if they can. We have to educate them about suicide prevention as well.

The second is, if I cannot get permission, to acknowledge when others say they heard it was a suicide. You can talk about it in the abstract even if you can't confirm. So when a child says, "I heard he killed himself" or "the paper says she took pills" I wills say, "I heard that too. If that were true, what do you think about that?" This finesses the whole question of telling when someone's death is a suicide by letting the students tell themselves. The AP could have written a story about the picture without publishing the picture, and explained that the family, who could be kept anonymous, did not give permission. This would have been a chance to talk about the impact of war on families at home, something they chose to gloss over by publishing the picture.

I think the AP, school administrators, and anyone else who has tough decisions to make about sharing or not sharing information, would do well to ask themselves what their ultimate goal is. If it's just to share information for its own sake, that takes you in a different direction than if, as in both of these cases, the aim is to educate. As the saying goes, there is more than one way to skin a cat, and there is more than one way to educate following a traumatic death.

I have chosen not to add the picture that the AP published of Lance Cpl. Bernard after his injury. I hope that the picture above is more in keeping with how the family would like this soldier remembered.