The Bereavement Of A Suicide.
MENTAL HEALTH VB
How suicide bereavement is different?
Bereavement by suicide shares characteristics with other bereavements and it is also different.
Understanding how and why it differs is helpful when you are supporting people who have been bereaved.
The grieving process is often complicated and typically lasts longer than other types of bereavement –
significant effects may still be felt for many years after the death. We are all individuals,
and each person will have had a unique relationship with the person who died –
there is no single or correct way to experience bereavement.
However, there are many common reactions and factors in bereavements by suicide.
Aspects of the experience of bereavement by suicide which make it different can include:
Circumstances of the loss
Emotional and physical reactions
The survivor’s questions – “why?” and “what could I have done?”
Stigma and isolation
Family and community tensions
Lack of privacy
Emotional and physical reactions
Bereavement by suicide can bring an intensity and range of emotions and physical reactions which may be
unfamiliar, frightening, and uncontrollable.
Emotional reactions are often complex, and people may find that they are experiencing a bewildering
range of feelings including guilt, anger, shame, rejection, sadness, and fear. People who have been bereaved by
suicide may become vulnerable to thoughts of suicide themselves.
Physical reactions may include tightness in various body parts, stomach pains, sleeplessness, and poor concentration.
Most people bereaved by suicide are haunted by two questions – “why did the person take their life?” and “could I have somehow prevented it?”. These are impossible questions to answer and eventually the person may have to either have to accept that they will never know or settle on an answer which they can live with.
It is natural that the bereaved person will take some considerable time in exploring these questions and it is an important part of the grieving process. However, it can also be damaging if they are unable to reach a stage
where the questions occupy less of their thoughts or if they cannot find an answer they can accept.
Self-esteem, confidence, and hope can be severely compromised.
Stigma and isolation
Death by suicide, even more than other types of bereavement, makes many people uncomfortable and unsure how to react. There is still a stigma attached to suicide, rooted in centuries of history and this generates misplaced associations of weakness, blame, shame or even sin or crime. This stigma can prevent people from seeking help when they need it and others from offering support when they want to.
There may be a desire to deny that the death was a suicide – this may be driven by cultural values or from a
sense of denial or of shame. This can create further confusion in an already complex situation.
Many people who have been bereaved by suicide find that they feel isolated. Others may avoid them, perhaps not knowing what to say or because they don’t want to upset the person. The sense of isolation may be especially acute if the bereaved person perceives other people to be uncaring or judgmental. Some people are unlucky enough to receive particularly thoughtless and malicious comments.
It may also be that the bereaved person avoids contact themselves – they may struggle to share their own feelings because they are fearful themselves of what they are experiencing, they don’t want to upset other people or they may worry about how to answer questions such as “how did he die?”
Family and community tensions
Whilst family and friends are often a great source of support, they can also be a source of tension and conflict. Sometimes families struggle to communicate, protective instincts kick in and they may be worried about causing more pain or about having a different view or feeling to others. Because the range of feelings and emotions experienced after a suicide can be so unfamiliar and frightening, people may be uncomfortable or scared to share.
Existing tensions and difficulties in family relationships can be surfaced as a result of the shock and trauma. Some people cope with their pain by blaming another person for the death – this may go as far as excluding them from the rest of the family, denying them the opportunity to attend the funeral and withholding information about the investigation. This can lead to huge rifts and a deep sense of hurt and isolation being added to the loss.
Losing a loved to suicide is one is one of life's most painful experiences.
The feelings of loss, sadness, and loneliness experienced after any death of a loved one are often magnified in suicide survivors by feelings of guilt,
confusion, rejection, shame, anger, and the effects of stigma and trauma.
Furthermore, survivors of suicide loss are at higher risk of developing major depression,
post-traumatic stress disorder, and suicidal behaviors, as well as a prolonged form of grief called complicated grief.
After the death of a loved one, regardless of the cause of death, bereaved individuals may experience intense and distressing emotions. Immediately following the death, bereaved individuals often experience feelings of numbness, shock, and denial. For some, this denial is adaptive as it provides a brief respite from the pain, allowing time and energy to accept the death and to deal with practical implications: interacting with the coroner's office, planning a funeral, doing what is necessary for children or others affected by the loss and settling the estate of the deceased. But, for most, the pain cannot be put off indefinably. It may not be until days, weeks, or even months following the death that the reality is fully comprehended, both cognitively and emotionally, and the intense feelings of sadness, longing, and emptiness may not peak until after that recognition sets in. Indeed, grief has been described as one of the most painful experiences an individual ever faces. Shock, anguish, loss, anger, guilt, regret, anxiety, fear, intrusive images, depersonalization, feeling overwhelmed, loneliness, unhappiness, and depression are just some of the feeling states often described.
Feelings of anguish and despair may initially seem ever present but soon they occur predominantly in waves or bursts—the so-called pangs of grief—brought on by concrete reminders of or discussions about the deceased. Once the reality of the loss begins to sink in, over time, the waves become less intense and less frequent. For most bereaved persons, these feelings gradually diminish in intensity, allowing the individual to accept the loss and re-establish emotional balance. The person knows what the loss has meant to them, but they begin to shift attention to the world around them.
Under most circumstances, acute grief instinctively transitions to integrated grief within several months. However, as described later, this period may be substantially extended for those who have lost a loved one to suicide. The hallmarks of “healing” from the death of a loved one are the ability of the bereaved to recognize that they have grieved, to be able to think of the deceased with equanimity, to return to work, to re-experience pleasure, and to be able to seek the companionship and love of others. For many, new capacities, wisdom, unrecognized strengths, new and meaningful relationships, and broader perspectives emerge in the aftermath of loss. However, a small percentage of individuals are not able to come to such a resolution and go on to develop a “complicated grief” reaction.
Complicated grief is a bereavement reaction in which acute grief is prolonged, causing distress and interfering with functioning. The bereaved may feel longing and yearning that does not substantially abate with time and may experience difficulty re-establishing a meaningful life without the person who died. The pain of the loss stays fresh and healing does not occur. The bereaved person feels stuck; time moves forward but the intense grief remains.
Symptoms include recurrent and intense pangs of grief and a preoccupation with the person who died mixed with avoidance of reminders of the loss. The bereaved may have recurrent intrusive images of the death, while positive memories may be blocked or interpreted as sad or experienced in prolonged states of reverie that interfere with daily activities. Life might feel so empty and the yearning may be so strong that the bereaved may also feel a strong desire to join their loved one, leading to suicidal thoughts and behaviors. Alternatively, the pain from the loss may be so intense that their own death may feel like the only possible outlet of relief.
Some reports suggest that as many as 10% to 20% of bereaved individuals develop complicated grief. Notably, survivors of suicide loss are at higher risk of developing this prolonged condition. Individuals can often have impairments in their daily functioning, occupational functioning, and social functioning.
Suicide survivors often face unique challenges that differ from those who have been bereaved by other types of death. In addition to the inevitable grief, sadness, and disbelief typical of all grief, overwhelming guilt, confusion, rejection, shame, and anger are also often prominent.11,35 These painful experiences may be further complicated by the effects of stigma36,37 and trauma.38 For these reasons, grief experienced by suicide survivors may be qualitatively different than grief after other causes of death.
Need to understand, guilt, and responsibility.
Most suicide survivors are plagued by the need to make sense of the death and to understand why the suicide completers made the decision to end their life. A message left by the deceased might help the survivors understand why their loved one decided to take his or her own life. Even with such explanations there are often still unanswered questions survivors feel they are left to untangle, including their own role in the sequence of events.
Another common response to a loved one's suicide is an overestimation of one's own responsibility, as well as guilt for not having been able to do more to prevent such an outcome. Survivors are often unaware of the many factors that contributed to the suicide, and in retrospect see things they may have not been aware of before the event. Survivors will often replay events up to the last moments of their loved ones' lives, digging for clues and warnings that they blame themselves for not noticing or taking seriously enough. They might recall past disagreements or arguments, plans not fulfilled, calls not returned, words not said, and ruminate on how if only they had done or said something differently, maybe the outcome would have been different.
Rejection, perceived abandonment, and anger.
Survivors of suicide may feel rejected or abandoned by the deceased because they see the deceased as choosing to give up and leave their loved ones behind. They are often left feeling bewildered, wondering why their relationship with the person was not enough to keep them from taking their lives.
Unlike other modes of death, suicide is stigmatized, despite recent valiant strides to destigmatize mental illness and suicide. Many bereaved individuals report that it can be difficult to talk to others about their loss because others often feel uncomfortable talking about the suicide. This can leave the bereaved feeling isolated.48 The feeling of being unable to talk about the death is often compounded by the perceived need to conceal the cause of death. At times, other people's belief systems, including that of the survivors themselves, can be a barrier to accepting the death and a deterrent to talking about it.
If you know someone who has lost a loved one to suicide,
there are many things you can do. In addition, by reaching out, you also help
take stigma out of the equation.
Don’t be afraid to acknowledge the death. Extend your condolences, express your feelings of sorrow. Make sure you use the loved one’s name. “My heart is so sad that John died.” Many who have lost someone to suicide have a broken heart, clinically called Stress Cardiomyopathy, and really need your empathy, compassion and understanding to heal.
Ask the survivor if and how you can help. Though they may not be ready to accept help, asking signifies that you are there—not avoiding or distancing during this tragic event. The notion of being there if needed is extremely comforting for survivors.
Encourage openness. Be accepting of however survivors need to express their feelings. It may be with silence, with sadness or even anger.
Be patient. Don’t set a time limit for a survivor’s grief. Complicated grief can take years to process. Moreover, don’t limit a survivor’s need to share and repeat stories, conversations or wishes. Repetition is a key factor in grief recovery.
Listen. Be a compassionate listener. This means don’t look to fix things. The greatest gift you can give someone you care about who has survived a suicide loss is your time, reassurance and love.
Ways to Help Yourself if You’re a Survivor of Suicide Loss
Ground yourself: It may be very painful, but you must learn to hold tightly to the truth that you are not responsible for your loved one’s suicide in any way, shape, or form.
Do not put a limit of your grief. Grieve in your own way, on your own time frame. It will take time to find a place for your sadness and loss. It may take even more time for you to feel hope again and envision possibilities.
Plan ahead. When you feel ready, assist your family in finding ways to mark your loved one's birthday, family holidays or other milestones. Understand that new moments, experiences or events will be met with sadness, even with emotional setbacks. Preparing for how you will move through these calendar dates will help minimize traumatic reactions.
Make connections. Consider joining a support group specifically designed for survivors of suicide loss. The environment can provide a mutually supportive, reassuring healing environment unlike anywhere else.
Give yourself permission. To cry. To laugh. To seek professional help if you need it. Remember that you are moving through the most difficult of losses—and you can take control of the path to healing.