Surviving suicide loss: Help, hope & healing

Every suicide leaves a family grieving and struggling to understand, for a loss through suicide is like no other, and the grieving can be especially complex and traumatic. Suicide is a difficult subject to discuss or write about, for several circumstances set death by suicide apart, and make the process of bereavement more challenging. Here’s why:

• A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, those who are left behind  the “suicide survivors”  may need to deal with the police or handle press inquiries. The survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help.

You may have recurring thoughts of the death and its circumstances, replaying the final moments over and over again in an effort to understand  or simply because you can’t get the thoughts out of your head. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

• Stigma, shame, and isolation. Suicide can isolate survivors from their community and even from other family members. There’s still a powerful stigma attached to mental illness (a factor in most suicides), and many religions specifically condemn the act as a sin, so survivors understandably become reluctant to acknowledge or disclose the circumstances of such a death.

Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another  thinking perhaps that particular actions or failure to act may have contributed to events  that can greatly undermine a family’s ability to provide mutual support.

• Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on or rejection of those left behind. So, the feelings of anger, rejection, and abandonment that occur are especially intense and difficult to sort out after a suicide.

• Need for reason. “What if” questions may arise after any death. What if we’d gone to a doctor sooner? What if we didn’t leave him/her alone by himself/herself? After a suicide, these questions may be extreme and self-punishing  unrealistically condemning the survivors for failure to predict the death or to intervene effectively or on time. Experts tell us that in such circumstances, survivors tend to greatly overestimate their own contributing role  and their ability to affect the outcome.

Many survivors need to conduct a “psychological autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide, in order to develop a narrative that makes professionals or friends listen  without attempting to supply answers  even if the same questions are asked again and again.

Support from other survivors

Research suggests that suicide survivors find individual counseling and suicide support group to be particularly helpful. Some people also find it helpful to be in a group with a similar kinship relationship, so parents are talking with other parents. On the other hand, it may also be helpful for parents to be in a group where they hear from other people, such as those who have lost a sibling  they may learn more about what it’s like for their other children.

Some support groups are facilitated by mental health professionals, others by lay persons. Experts feel that if you go and feel comfortable and safe  and feel that you can open up and won’t be judged  that’s more important than whether the group is led by a professional or a lay person.

For those who don’t have access to a group or feel uncomfortable meeting in person, Internet support groups have been a growing resource  at least in other countries. Those who have made use of this method liked the unlimited time and 24-hour availability of Internet support.

Getting professional help

Look for a psychiatrist or other mental health professionals who are competent and experienced in working with grief following the loss of a loved one. They can support you in many ways, including these:

• Help you make sense of the death and better understand any psychiatric problems the deceased may have had.

• Treat you, if you’re experiencing PTSD.

• Explore unfinished issues in your relationship with the deceased.

• Aid you in coping with divergent reactions among family members.

• Offer support and understanding as you go through your unique grieving process.

Immediately after the suicide, assistance from a psychiatrist may be particularly beneficial if you experience any of the following:

• Increased depression (or if you have a history of depression).

• Flashbacks, anxiety, or other symptoms of PTSD.

• Unwillingness of family or friends to continue talking about the loss.

• Suicidal thoughts or plans.

• Physical symptoms, such as ongoing sleep problems, significant weight gain or loss, or increasing dependency on tobacco or alcohol.

• Feeling of being stuck or unable to move forward (however slowly and painfully) in the grieving process.

• Discomfort in discussing troubling aspects of your relationship with the deceased.

• Little improvement after several months.

A friend in need

Knowing what to say or how to help after a death is always difficult, but don’t let fear of saying or doing the wrong thing prevent you from reaching out to suicide survivors. Don’t hold back. Just as you would after any other death, express your concern, pitch in with practical tasks, and listen to whatever the person wants to tell you. Here are some special considerations:

• Stay close. Families often feel stigmatized and cut off after a suicide. If you avoid contact because you don’t know what to say or do, family members may feel blamed and isolated. Whatever your doubts, make contact. Survivors learn to forgive awkward behaviors or clumsy statements, as long as your support and compassion are evident.

• Avoid hollow reassurance. It’s not comforting to hear well-meant assurances that “things will get better” or “at least he’s no longer suffering.” Instead, the bereaved may feel that you don’t want to acknowledge or hear them express their pain or grief.

• Don’t ask for explanations. Survivors often feel as though they’re being grilled. Was there a note? Did you suspect anything? The survivor may be searching for answers, but your role for the foreseeable future is simply to be supportive and listen to what they have to say about the person, the death, and their feelings.

• Remember his/her life. Share memories and stories. Use the person’s name (“Remember when Mario taught my daughter how to ride a bike?”). If suicide has come after a long struggle with mental or physical illness, be aware that the family may want to recognize the ongoing illness as the true cause of death.

• Acknowledge uncertainty. Survivors are not all alike. Don’t assume that another person’s feelings and needs are the same. It’s fine to say you can’t imagine what this is like or how to help. Follow the survivor’s lead when broaching sensitive topics. “Would you like to talk about what happened?” (Ask only if you’re willing to listen to the details.) Even a survivor who doesn’t want to talk will appreciate that you asked.

• Be there for the long haul. Even if a survivor isn’t bringing up the subject, you can ask how he/she is coping with the death and be ready to listen (or respect a wish not to talk about it). Be patient and willing to hear the same stories or concerns repeatedly. Acknowledging emotional days such as a birthday or anniversary of the death  by calling or sending a card, for example  demonstrates your support and ongoing appreciation of the loss.

Indeed, the grief process is always difficult, but it can be especially complicated after a death from suicide.

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Sources: American Association of Suicidology  www.suicidology.org; American Foundation for Suicide Prevention  www.afsp.org; Dying to be Free: A Health Guide for Families After a Suicide by Beverly Cobain and Jean Larch (Hazelden Foundation, 2006); Silent Grief: Living in the Wake of Suicide by Christopher Lukas and Henry Seiden (Jessica Kingsley Publishers, 2007); and Understanding Your Suicide Grief: Ten Essential Touchstones for Finding Hope and Healing Your Heart by Aslan D. Wolfelt, Ph.D. (Companion Press, 2009).