After Suicide

by Mary de Courcy

In the past month, December 2011, I have heard about 5 suicides in random encounters; the local shop, the hairdresser, at choir practice. None of those relating the events were judgmental, critical or hostile. All were sad, reflective and a bit numb. We did not discuss the details. There were no names or gossip, rather each retelling was characterized by a quiet sadness and a loneliness for someone whom none of us may have known; yet all felt the loss of. Someone in our society, perhaps in the community or our family had decided to end his, or her, own life.

Among my personal and professional relationships several have ended in suicide. Part of the difficulty in writing is not having a language to describe such decisions and deaths. However I would like to try to describe the impact of these deaths on me and by extension on those around me. Death by suicide, suicide victims, choosing to die, death by one’s own hand, I don’t know the language of suicide. Does anyone?

Each week in the newspaper there is a short announcement or a gentle tribute to a suicide victim. Some are young teenagers, some healthy young adults. Some are in their middle years while others are elderly. Men, women, boys, girls, the healthy, the well: those who die by suicide are amongst us all. Articles speak of societal loneliness or severe depression. They cite failed relationships and financial pressures. Issues like loss of identity, loss of meaningful connection, the impact of debilitating illness and the breakdown of the family are trundled out for inspection. Support groups, health professionals, local and national helplines struggle to provide contact with those who struggle to live. Yet it seems it is not enough. Many who succeed in dying by suicide have been in contact with such organisations and individuals. Most have families with whom they retain contact. Many have jobs and responsibilities. Many of the adults who choose suicide have dependents; children or aging parents who rely on them. Suicide is an option, but so is life. Why is life so unbearable for so many that they cannot continue?

Impulsiveness, alcohol and drug abuses are generally associated with teenage and early adult deaths. So are rows with friends, with parents, in school and with authorities. Copycat suicides and suicide pacts are often referred to amongst this group and easy access to social network sites moves information rapidly from continents to cities to small villages. Reaction in isolation rather than reflection amongst peers and family characterise the readers of these sites. A young man I met struggled to come to terms with the suicidal death of his school friend. He blamed himself and was consumed with guilt as he talked of being the last person the school friend had spoken to. He understood the suicide as he too had tried to die. He had been saved and now regretted surviving as he felt that if he had died, his friend, shocked and saddened, might have lived. That young man was full of pain, of remorse, of guilt. I don’t know if he’s alive.

The suicides of older adults are rarely impulsive. Most are planned and often for a period before the day chosen to die the person is described as ‘in good form,’  ‘upbeat and back to himself,’ ‘had been depressed but was much better.’ Generally speaking planned suicides result in an internal calm. A decision has been made, a method, a time and day chosen. Death by drowning, gunshot, pills, poisons, jumping and hanging are some of the varied ways in which a person may choose to die. Death by suicide is almost always violent. Pills and poisons may be portrayed as a gentle exit, yet coroners and autopsies will show that to be untrue. While suicides in this age group may be associated with addictions, depressive conditions and failed relationships there does not appear to be any single pattern of suicide associated with any specific group. Yet one fact seems unconsidered by those who choose to die; the impact on those left behind, the impact on the person who finds the dead person. Memories may continue to haunt for decades. Identification with a parent or sibling who has died by suicide may cause years of fear that suicide awaits. Familial histories of suicide may linger in the family’s collective memory for generations.

And the impact on me, and you, on those of us left behind can also be violent in the anxiety, anger and fear which are so often our legacy. An older woman rang one night. It was raining heavily and she was sitting alone in her car in an empty shopping centre car park with a second bottle of red wine having swallowed 40 paracetemol. She sobbed her distress and rage. The memory of that phone call, my warm kitchen and her freezing despair remains with me. She survived that night. I don’t know if she is still alive. A friend from long ago has survived three suicide attempts, has brain damage and a wizened body. I grieve for the loss of our friendship. I don’t know if she is alive.

As practitioners we can consider theories of adult attachment, of childhood experiences of attachment and separation, of in utero experience, of the moments of conception. We can consider family dynamics, patterns of self-harm, of addiction, of generational abuse and hardship. We can discuss mental distresses: psychosis, dissociation and psychotic episodes. We can strive to engage the client in healthy pursuits, good relationships and beneficial patterns of living. We can encourage expression and creativity. We can connect with unconscious desire through dreams, the body and somatic illness. We can delve into Jung and Freud, Winnicott and Mahler. We can explore psychoanalytic and psychodynamic therapies, cognitive and solution-focused approaches. We can put demons on empty chairs, and use marbles and figures for those who find it hard to speak. We can journey with our clients along paths of guided imagery, meditation, body scans and mindfulness. We can refer clients to psychiatry where a psychiatric version of this list can be employed. Perhaps the question is not, how can we save, but can we save someone who can go no further? Not, how can we reach, but can we reach someone who has made the decision to die? Can we sit in the helpless place?

Theories of evolutionary development suggest that one of our strongest instincts is to survive. We’re familiar with phrases like the survival of the fittest and only the strongest will survive. We’re also familiar with the concepts of self-sacrifice: Inuit elders who can contribute to the community no longer and decide to die, Buddhist monks who self-immolate as the ultimate protest against political cruelties, Jesus who sacrificed his life for the greater good. Many who die by suicide write similar ideas: my family would be better off without me. I’m too much of a burden. You’ll stop worrying when I’m gone. Could suicide be construed as the ultimate sacrifice? Might the choice to die be seen as the ultimate act of love? Whether a person makes the decision to die as a result of terminal illness, or because of relentless sadness, might the intention be to lessen the burden on those they love? Might the wish be that self-sacrifice will release some of the tensions and anxieties of those left behind?

From this viewpoint I find it hard to think of suicide as a selfish act. That seems to me to be too harsh. I shrink from the idea that suicide weeds out the psychologically weak rather like the plagues and epidemics that have decimated the physically weak. But it leads me to wonder whether we could begin to think of suicide under different categories, begin to see those who choose to die as different from each other, making their decisions from varying points of view. Could we consider seeing suicide under such headings as; those who struggle with a fragmented mind and choose to die, those who are in the later years of their life and, like the Inuit, choose death in order that others might live, those who feel they are too much of a burden and that their suicide will provide relief to their families. Might we look at the issue of suicide not from one perspective but from different origins, and find ways to talk about suicide from a wider breadth of vision.

The medical model of treating the body by separating different systems, rather than only as a single system might provide an approach. While medical advances have greatly improved our physical bodies, we have far to go in our understanding of our psychological selves. Could we separate young people and their struggles to live from older people and their wish to die? Could we separate a young mother who sacrifices herself and her child in order that her child will not have to go through the torment she has known, from the terminal illness sufferer who chooses to die with dignity?  While holding our holistic approach could we also consider a person from a psychological systems perspective, a psychological etiology?

As people; parents, friends and colleagues how do we cope? As practitioners and supervisors how do we manage amidst a sorrow which must remain private? Shock, surprise and sadness have been my initial reactions to the deaths by suicide that I have encountered. Relationships with people I loved and valued have ended abruptly. There has been no therapeutic ending, nothing to soften the violent severing of our connection. I hold and contain, but often that is so painful. I let go and trust that the universe will support me, but that too can provoke anxiety about who might be next. Ritual helps: candles, spaces and silence in the natural environment, birdsong, and my abundant pond which throbs and heaves with fish, frogs and pond skaters. Laughter with friends, being with my cherished family and breathing gently into our shared air helps to steady me. Yet pain remains in my heart for those who could struggle no more. My wish is that those who have chosen an untimely death, and those who remain to grieve find gentleness and comfort. One thing I know, I will not forget them.

Mary de Courcy is a psychotherapist, supervisor and trainer in Dublin.