Grief is a universal experience all human beings encounter. Though death inevitably touches our lives, research shows that many people grieve in varying and different ways. From the textures of emotions, to length of time in mourning, to even the kinds of rituals and remembrances that help heal the irreplaceable loss. Grieving the death of a loved one is never, ever easy.

Suicide, however, has been described as a death like no other ... and it truly is. Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss.

Who is a Survivor of Suicide Loss?

Despite science supporting a neurobiological basis for mental illness, suicide is still shrouded by stigma. Much of the general public believes that death by suicide is shameful and sinful. Others consider it a “choice that was made” and blame family members for its outcome. And then there are people who are unsure how to reach out and support those who have lost a loved one to suicide, and simply avoid the situation out of ignorance. Whatever the reason, it is important to note that the underlying structure of grief for survivors of suicide loss is intricately complicated.

When someone dies by suicide, research shows that at least 6 people are intimately traumatized by the death. Those who are directly affected include immediate family members, relatives, neighbors, friends, fellow students and/or co-workers. And because 90% of people who die by suicide have a psychological disorder, mental health clinicians are also included as a survivor of suicide loss.

From the nearly 800,000 suicides reported from 1986 through 2010 and using the 6 survivors per suicide estimate, it is believed that the number of survivors of suicide loss in the U.S. reaches 5 million people.

Understanding Suicide

Based on the accounts of those who have attempted suicide and lived to tell about it, we know that the primary goal of a suicide is not to end life, but to end pain. People in the grips of a suicidal depression are battling an emotional agony where living becomes objectionable. Most people who die by suicide have a significant depression narrowing their problem solving skills. Corrosive thinking reduces optimism, the hope of possibility and increases feelings of helplessness. The depressive illness itself makes it virtually impossible to hold onto any semblance of pain going away. While some may argue that a person who dies by suicide has done so by their own choice, I argue that serious mental illness, in fact, limits choice. Studies of those who have survived their suicide attempt and healed from their depression report being astonished that they ever considered suicide. 

Why Grieving is Different

Research has long known that suicide survivors move through very distinctive bereavement issues. Family and friends are prone to feeling significant bewilderment about the suicide. Why did this happen? How did I not see this coming? Overwhelming guilt about what they should have done more of or less of —become daily, haunting thoughts. Survivors of suicide loss often feel self-blame as if somehow they were responsible for their loved one’s suicide. Many also experience anger and rage against their loved one for abandoning or rejecting them—or disappointment that somehow they were not powerful enough, loved enough or special enough to prevent the suicide.     

These mistaken assumptions plague survivors of suicide loss for a very long time. Many struggle for years trying to make sense of their loved one’s death—and even longer making peace—if at all—with the unanswerable questions that linger.

Society still attaches a stigma to suicide. And as such, survivors of suicide loss may encounter blame, judgment or social exclusion - while mourners of loved ones who have died from terminal illness, accident, old age or other kinds of deaths usually receive sympathy and compassion. It’s strange how we would never blame a family member for a loved one’s cancer or Alzheimer’s, but society continues to cast a shadow on a loved one’s suicide.

What also makes grieving different is that when we lose a loved one to illness, old age or an accident, we retain happy memories. We can think back on our loved one and replay fond memories, share stories with joyful nostalgia. This is not so for the suicide survivor. They questions the memories, “Where they really good?” “Maybe he wasn’t really happy in this picture?”Why didn’t I see her emotional pain when we were on vacation?” Sometimes it becomes agonizing to connect to a memory or to share stories from the past—so survivors often divorce themselves from their loved one’s legacy.        

Survivors of suicide loss not only experience these aspects of complicated grief, they are also prone to developing symptoms of depression and post-traumatic stress disorder—a direct result from their loved one’s suicide. The unspeakable sadness about the suicide becomes a circle of never ending bewilderment, pain, flashbacks and a need to numb the anguish.

Ways to Help a Survivor of Suicide Loss

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.   

  1. 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. 
  2. 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.
  3. Encourage openness. Be accepting of however survivors need to express their feelings. It may be with silence, with sadness or even anger.
  4. 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.
  5. 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

  1. 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.
  2. Don’t 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.
  3. 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.
  4. 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.
  5. 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.

Citations 

Feigelman, W., Gorman, B.S. & Jordan, J.R. (2009). Stigmatization and suicide bereavement. Death Studies, 33(7):591-608.

Hendin H, et al. (2000). Therapists' reactions to patients' suicides. American Journal of Psychiatry, 157(12):2022–2027.

Jordan, J. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life-Threatening Behavior, 31: 91–102.

Sakinofsky I. (2007). The aftermath of suicide: Managing survivors' bereavement.  Canadian Journal of Psychiatry, 52(6):129S–136S.

Sudak, H., Maxim, K., & Carpenter, M. (2008). Suicide and stigma: A review of the literature and personal reflections. Academic Psychiatry, 32(2):136-142.

Young,  I. T. et. al. (2012). Suicide bereavement and complicated grief. Dialogues in Clinical Neuroscience, 14(2):177-186.

Dr. Deborah Serani is author of the award winning books Depression and Your Child: A Guide for Parents and Caregivers and Living with Depression by Rowman & Littlefield.

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