Sam Savage finds that his sorrow has subsided a bit.

“It’s become more bearable. My appetite is back and I can sleep through the night again. But it’s still there,” said Savage, 27, of Minneapolis. “Time heals, but a death, particularly a suicide, you carry with you.”

Savage’s brother Jack, 24, killed himself in April after struggling with depression.

The family didn’t want flowers for Jack, whom they describe as artistic and kind. Instead, they used Jack’s obituary to ask for memorial donations to NAMI, the National Alliance on Mental Illness.

“Putting in that NAMI request let people know,” said Savage. “My family didn’t feel like we needed to hide the suicide. It’s silly to lie. If the family is open about it, then everyone else can be. It helps all of us.”

By its very nature, a suicide is shocking and sudden. And it has almost always been shrouded in euphemism or outright deceit. Even family members and close friends may not be told the painful truth. But more families are choosing to acknowledge when suicide is the cause of death.

“We’ve seen quite an increase in suicide being included in obituaries in the past two or three years,” said Sue Abderholden, executive director of NAMI Minnesota. “Until very recently, it was unheard of. It’s important because families get support when they say it. We encourage it.”

Dan Reidenberg, a psychologist and executive director of SAVE, a suicide prevention organization based in Bloomington, said that acknowledging suicide can do even more than help surviving relatives and friends.

“It reduces the stigma,” he said. “When we can regard mental illness like any other illness, it says there is no shame in having it.”

Reidenberg said he’s seeing a positive shift in the shared understanding that mental illness is not a character flaw.

He cites an influential study that appeared this year in the Journal of Crisis Intervention and Suicide Prevention, a scholarly journal. Researchers showed study participants identical fictional newspaper obituaries. Some participants saw cancer named as the cause of death, while others saw suicide. Follow-up questions showed that respondents were as willing to extend sympathy and support to the family after a suicide as to the family who lost a loved one to cancer.

“This is significant because it shows the perception of mental illness is evolving,” Reidenberg said. “It indicates that more people no longer blame families or believe that families caused it.”

Without shame or blame

It was 13 years ago Kitty Westin’s daughter Anna ended her life. The 20-year-old had been diagnosed with an eating disorder four years earlier.

“The funeral director who was helping us write the obituary was trying to help,” said Kitty Westin, 62. “He suggested that we say, ‘She died at home.’ I said ‘No. We’re not saying that. We’re saying she died of anorexia.’ It didn’t occur to me to be ashamed. Anna was sick. She had a horrible illness.”

Anna Westin’s death turned her mother into an outspoken advocate for families living with mental illness and eating disorders. As advocacy director for the Emily Foundation, Westin campaigns for a more forthright approach. “It serves a purpose when a family can state it when someone in their family had an illness that led to their death,” she said. “It can change the conversation. It can make it OK to get treatment for an illness.”

NAMI Minnesota is trying to broaden that conversation. The organization routinely sends out mass mailings to help funeral directors who may deal with families grieving a suicide.

“We tell them what words families have found helpful and healing,” Abderholden said, phrases such as “he struggled with schizophrenia yet lived life with courage and compassion,” or “she bravely lived with depression and is at peace now.”

SAVE also offers guidance about how families can name suicide in the eulogy or obituary, and offers suicide-specific literature for memorial gatherings.

“We understand that not everyone is ready to go public,” said Reidenberg. “We always want to keep the focus on the person, not the suicide. When it’s not addressed, rumors and questions can be rampant and that doesn’t help the community.’ ”

Moving toward openness

Tom Ellis, a former funeral director and licensed family therapist, teaches funeral service psychology for the School of Mortuary Science at the University of Minnesota.

Ellis said he’s found that some older clergy members and funeral professionals may have trouble with the newer, more direct approach to suicide. He said some still harbor notions that suicide is sinful, or that a family should cover up the cause of death to protect their social standing.

That’s changing, he said. Funeral directors of the future will probably be more frank in their approach, partly because the topic is included in the curriculum.

“It is a more complicated grief process, but when this traumatic loss is shaded by shame, it puts an unrealistic — and unfair — level of responsibility on the family,” Ellis said.”We teach our students that the funeral director can give a family permission to be open about it and can be a bridge to connect them to community resources.”

Sam Savage was in his last semester of law school when his brother died last spring. He was particularly touched by a card his classmates passed around, signed and sent to him.

“They all knew how he died. For most of us, it’s not the first time we’ve encountered it,” Savage said. “Unfortunately, it happens.”

Savage doesn’t know if the openness will help his family’s healing. “Call me in a few years,” he said.

But those who work with survivors think that it might.

“When it’s not spoken of, it sends a message to the next generation that says ‘We must deny the truth,’ ” Ellis said. “Actually, we know that the opposite is true. We must talk about it.”

Kevyn Burger is a free lancer writer and a newscaster at BringMeTheNews.