Grief After Suicide
By Dr. Bill Webster
“You never get over a suicide. You just learn to deal with it. The worst part is not knowing WHY. If I could just say he had been depressed, or seeing a shrink, or anything that might have explained it, it would have been better. But I just don’t know why he did it” -Julie (whose teenage son hung himself)
Jim’s 29 year old son had suffered from severe manic depression for 4 years when he jumped from a high rise apartment building. Jim DID know a reason, but found that to be of little comfort:
“It was just unbelievable to me. Why did he do this? Why didn’t he come to me for help? And then I felt anger. For four and a half years, I had done everything under the sun to help him. What else could I have done? I felt very guilty because if I could have helped my son, I would have done anything.”
While we often correctly say that “there is no such thing as more or less difficult, it is just different”, there are some situations that are uniquely difficult. One is the loss of a child. Another is a death by suicide. And when these two situations come together, as it did for both Julie and Jim it can be a devastating blow to “suicide survivors” (this term for the purposes of this article refers to those who have lost someone to suicide.)
It is not my intention to outline the many and varied theories of suicidal behavior, many of which are conflicting. The focus here is on how we help support suicide survivors through their unique process. There are some sobering facts, however:
Every day, throughout the world, over 1000 people complete suicide
It is estimated that for every suicide there are 15 unsuccessful attempts
White males over the age of 50 make up approximately 10% of the population but account for 28% of the total suicide deaths
Men complete suicide three times more than women, but women attempt suicide five times more than men. Most attempts of suicide are made by women in their 20′s and 30′s
Suicide tends to run in families, but it is learned not genetic. Often it is unconsciously suggested as a means of coping with overwhelming moments.
People who talk about suicide complete suicide. Suicide RARELY happens without warning
When someone completes suicide, the mourning process for survivors is different in at least 2 ways. 1) The period of numbness and disbelief will be longer, extending the duration of the grief process; and 2) there is the added burden of understanding the motivation for the death.
For suicide survivors, the grief process is particularly long given the complexity of issues survivors struggle with. This means that one year after the death, the griever may still be in the depths of their grief, long after society expects people to be over their grief. Jim observes:
“I think before the grief really set in, it took over a year. I mean there are times when I still think this is unbelievable. But I think it took a year for me to really believe it. And I think that it was because I surrounded myself with him, looking at pictures, and talking about him to everyone that helped me come to terms with it in such a short period of time. I don’t know if a year is a short period of time or not, but it is very real to me today.”
For this reason, patience on the part of the helper is most important. There is no way to speed up the grief process. One can only go through it! Our task as helpers is to provide a safe and nonjudgmental environment where the griever can begin the telling of “the story” (of the life and of the death) and develop effective tools for dealing with their grief.
Perseverance is also required because, for many survivors, basic trust in relationships with others was broken when the person contemplated suicide. This means that it is often difficult for them to establish new relationships because they feel cautious about reconnecting or new connections.
One of the differences in the grief process after suicide is that the act involves a conscious choice, which is different than sudden death through accidents or cancer. It is this element of “choice rather than chance” that complicates the grief process.
The following is an example of some of the things survivors might say to themselves that lead to these feelings:
Shame “What would people think of me if they knew my child completed suicide?”
Blame “I must have been a lousy parent if my child killed himself!”
Guilt “I noticed she was depressed. Why didn’t I do something?”
Anger “How could he do this to me?” You saw your loved one’s life as viable; they saw it differently and chose to die. That is difficult to understand and impossible to bear. So often, after disbelief, the next reaction is anger and outrage. The survivor may feel the deceased acted with contempt towards them. Or perhaps they perceived themselves as unloved. Either way, we ask why they didn’t see how hurtful this would be, or why they did not seek alternatives.
Fear “Will my other children end up killing themselves too?”
Relief “It’s finally over!” (This feeling is more evident in cases where the person who died was abusive or had a long-standing difficult history of mental illness)
Rejection “I guess he didn’t really care about me or he would still be alive.”
Hopelessness “What’s the point in going on?”
Confusion “How could this have happened? I just saw her yesterday and she looked fine.”
Isolation “I feel so ashamed and guilty about Joe’s death that I don’t want to see anyone. I bet they blame me for his death.”
There are four areas of discussion and counsel that are particularly helpful to suicide survivors:
Listening to the story of the death
Expressing and understanding feelings
Anniversaries and special occasions
Stress, coping and using support systems
Listening to the Story
To facilitate the telling of the story of the death, it is important to create a supportive atmosphere through gentle probing. We have included a number of questions that we commonly ask survivors to assist them in the telling of the story. These appear in the Appendix at the end of this chapter. The suggested questions in the appendix could leave the impression of an interrogative approach, if used verbatim, without proper nuances in timing and pacing.
The point to be made in asking these types of questions, is that the story needs to be protracted and spun out, through a recounting of the many details of what happened.
Many survivors feel uncomfortable talking to friends about the details of the suicide as they feel that these details are too horrific for others to absorb. Families sometimes avoid talking about difficult and painful parts of the story, even in discussions with one another. The fear is that these difficult elements may be too over-overwhelming for family members to bear because of their own grief. As bereavement counselors it is our job to be able to tolerate the intensity of emotion and detail that the telling of the story can bring about.
The initial goal is to have the family tell the story of the death of their relative or friend. It is through recounting the details that a number of key processes are likely to occur, these being:
Each person will begin to ascribe meaning to the suicide ( a beginning for the ever present question “Why?”)
Each person will begin to experience some relief through acknowledging, identifying and working through their feelings of loss.
Each person will begin to create their own understanding about what has happened.
Further relief will occur through the experience of talking in a supportive atmosphere that allows the expression of all the details, feelings and thoughts related to the death.
One of the advantages of dealing with issues related to grief through suicide, in a group context, (familial or otherwise), is that the isolation that this grief can produce will be reduced through people coming together to talk about their experience.
From our experience, families who feel they have had an opportunity to tell the whole story, related to the death, and who feel their story has been validated, are better able to move on to issues in the present. Families who have not had assistance in understanding and making sense of the death are far more likely to get stuck in the repetitive talking about the death without resolution.
Going over the events in detail allows family members to hear each others perspective, to appreciate that everyone is in pain and to realize that they may all be at different stages in their grief, with each attributing a different meaning to what has happened.
It is helpful to encourage tolerance for differences by helping members listen to each others different explanations and interpretations and to accept that each one’s perspective and rate of acceptance of what is happening is okay. The tendency can be for each person to want to convince the others that his or her version of the “truth” is the only “truth”. Families who are struggling to understand the death, often ask counselors to answer the question of why did she or he kill themselves. The task is to educate the family through providing information based on other families’ experiences e.g. “Other families have told me but this won’t necessarily fit for you.”
As you listen to the story, it is useful to prepare yourself by having a clear understanding of your own beliefs and values to do with suicide. One way of orienting yourself to these values is to examine and explore some of the popular myths regarding suicide e.g. “A person who completes suicide is mentally ill.” Although this is considered to be more false than true, if the family has decided that their relative was mentally ill and is now free of the pain of that illness, it will be of no comfort to them if you espouse your view that John was not necessarily mentally ill when he hung himself. It is important that this understanding of one’ s own values and beliefs pertaining to suicide are examined prior to working with families so as not to interfere with the process.
There are some important differences for a person grieving a death through suicide versus other types of loss. This is not to minimize the effect of other types of loss but more to raise awareness for the helper of certain processes and feelings which will be more prevalent and harder to come to terms with for family members.
Expressing and Understanding Feelings
As mentioned previously, feelings that are likely to be more intense after a suicide than after most other types of loss include the following: