Today is National Survivors of Suicide Day
National Survivors of Suicide Day
Grief and Mourning After Suicide
by Norman L. Farberow, Ph.D.
Bereavement for the loss of a loved one is a complex and idiosyncratic experience, with each person mourning at his own pace and in his own way; yet the process is surprisingly uniform. Survivors of deaths due to natural causes, accident, homicide or suicide experience comparable phases of shock, disbelief, protest, disorganization, yearning, and, eventually, reorganization. Similar feelings of depression, grief, anger, anxiety, guilt, physical symptoms and emotional distress develop.
Clinical observations, however, consistently confirm that the experience of surviving a loss to suicide is more difficult, more complicated, and more intense. Although many suicidal behaviors may precede a suicide, its suddenness will still shock. Death by suicide is frequently violent and bloody. Finding a loved one after a shot to the head, or having to cut down a hanging body may leave the family member with nightmares, severe anxiety, intrusive memories and other symptoms of post traumatic disorder. Feelings of abandonment and rejection are common in survivors who feel that the decedent willingly chose to separate, to leave behind loved ones and friends, to permanently and non-negotiably sunder bonds with spouse, parents, children and siblings. These feelings are hard to reconcile, and suicide survivors may be left with persistent, troubling concerns.
Surviving a loss to suicide is more difficult, more complicated, and more intense [than for any other loss].
Particularly the need to understand "why" drives survivors to search and review endlessly, hoping to find some logic in the act that will allow their feelings to be tolerated. In extreme cases, the need to find this answer may become an obsessional preoccupation that derails the bereavement process, while all too often death has made this answer inaccessible.
Clinical reports show that not only has the suicide branded the decedent as psychologically damaged, it has often left the survivor feeling stigmatized and defective. Survivors may have a potential for themselves dying by suicide because of the example set by the suicide of their loved one.
Other feelings frequently found in excess are guilt and anger. Guilt feelings may plague the survivor with questions of "what if" and thoughts of "if only". Constant rumination over the events leading up to the death may leave the survivor convinced it could have been averted if only he had said this, or done that. Sometimes the guilt is projected onto others, and therapists, lovers, or family scapegoats may be blamed. When survivors fix blame on an outside source, their intense anger may dismiss all sources of help, even for unrelated problems.
Suicide affects the readiness of the survivor to trust -- fears of abandonment may provoke hesitancy toward commitment to any subsequent relationship. Suicide death in our society is often a source of shame and embarrassment -- suicide survivors get less social support and experience more intense feelings of guilt than survivors of other modes of death. Feelings of stigma may cause the survivor to withdraw at the same time that social taboos on discussing suicide cause friends to feel awkward and uncomfortable. The end result is the absence of supportive and comforting friends who would customarily have made themselves more available for emotional and practical support at the time of a loss by death.
Not every survivor needs therapy, and not every therapist should treat survivors. Needs differ, so that some survivors react to the death by seeking therapy immediately, while others mourn for a long time and recover slowly. Some develop somatic conditions, which are directly or indirectly attributed to the loss; when the symptoms are unusual and unrelieved, treatment is indicated. Severe depression, intense guilt, self-blame and suicidal feelings and behavior may appear along with withdrawal from customary social networks. The therapist must be non-judgmental of any treatment the deceased received, and should not blame the family nor the suicide.
Treatment may be offered to individuals, groups, or to families. Family therapy is indicated when the suicide affects the family severely, disrupting its functioning and producing scapegoating, blaming and isolation. While there have been few systematic evaluations of these treatment modalities, group therapy is usually the treatment chosen, as it offers survivors opportunities to discuss their feelings in a sharing atmosphere, to find that their feelings were typical and normal, and to find care and support. The exchange of experiences in the group helps teach group members a variety of coping strategies. The feeling of helping each other often serves to relieve strong feelings of anger and frustration at not being able to help their loved one.
Despite the lack of research, it has been gratifying to see how quickly therapists have developed creative clinical responses to serve survivors who experience severe psychological distress. Bereavement, grief, mourning, and survivorship are all part of a new field that is only now being studied. There is much work to be done.
Dr. Farberow is Clinical Professor of Psychiatry (Psychology) at the University of Southern California School of Medicine and a member of AFSP's Scientific Advisory Council. This article is reprinted from AFSP's Lifesavers newsletter.
Thinking of all who have lost a loved one to suicide. Close