by Mary Murphy
Suicide is the act of deliberately or intentionally taking one’s own life and is “by its very essence … an act against the self” (Parkes, 2000). Although the person who takes their own life escapes from their psychological pain (the ‘psychache’), they pass on their unbearable feelings to the survivors (Shneidman, 1993). The ‘psychache’; the shame, guilt, humiliation, anger, loneliness, angst and other emotions associated with suicidal states frequently become the survivor’s legacy. Shneidman refers to these as the psychological skeletons which are left in the survivor’s closet.
There are various estimates about the number of people affected by each suicide death. Shneidman (1969) suggested that for every death, six people would suffer intense grief. A bereavement is a loss (Parkes,2009) whilst grief refers to one’s personal experience of loss and includes physical sensations, feelings, cognitions and behaviours. The impact suicide has on any individual family member depends on a number of factors including the family dynamics and history, how problems, issues and disturbances are dealt with within the family, whether the suicide has been anticipated and the degree of disturbance already present in the family.
Death by suicide also impacts on others such as colleagues and neighbours as well as mental health professionals; Nurses, GPs, Psychiatrists and Psychotherapists. Studies have shown that professionals working in the field experience loss, shock, sadness, anger, fear and relief as well as feelings of professional failure and concern for their reputation amongst colleagues. (Grad, 1997).
‘Death by suicide is a rejection of the central supportive and healing intent of the services. It strikes at the very raisond’être of the health care professional….As healers and helpers, members of a caring profession; the suicide shows us to have failed. It challenges our omnipotent fantasies, our belief in our capacity to help, to cure, to save’.
The suicide bereaved are faced with a death which is often unexpected, untimely and possibly violent and whether or not they are the one to find the body they may be left with horrific images of the death scene (Shneidman, 1982). Zistook (1998) found in a study of widows and widowers that a third of those bereaved by suicide or accidental death experienced symptoms of post-traumatic stress disorder. Denial and disbelief are common features particularly in cases where the survivors find out about the death from a complete stranger and/or when it happens many miles away (Bowlby, 1985). One survivor’s account in ‘A Special Scar’ tells about a mother waking up after her daughter died by suicide ‘trying to believe, trying to accept. You don’t; you can’t. It’s like someone giving you a pill that’s big and saying “swallow that”. It’s impossible, it won’t go down. You’ve got to chip away a bit at a time’.
Then there is the exhaustive search for ‘why’ as suicide can seem such a meaningless act (Hauser, 1987). The preoccupation with the search for an answer can take a long time as the only person who can really answer the question is no longer available for questioning.
In these traumatic situations “the tendency to apportion blame is likely to be enormously increased” (Bowlby, 1985). There may be silent or not so silent accusation about who was at fault, who was responsible and who should have done more. For instance where the person who died by suicide was married, the in-law may be held responsible by the grieving parents. Individuals will have different ways of coping with their grief and these differences can themselves lead to friction and perhaps a sense of isolation.Survivors can blame themselves too for not knowing, not having done more and/or for not realising how bad the deceased must have been feeling. Worden (2003) says that guilt can sometimes be manifested as blame where the survivor’s own sense of culpability and feelings of guilt is projected onto others and so others are to blame for the death.
Worden (2003) identifies guilt as a common reaction to bereavement but says that guilt may be more prevalent when the death was a suicide. The bereaved may feel they contributed to the death because of what they did or were unable to do. They may feel they should have prevented it. They may blame themselves too for the state of the relationship with the deceased person prior to death. “If only” is a common phrase used to describe acts which might have helped to prevent the suicide. Added to that, guilt may also be felt because the suicide bereaved may feel relieved (Clark and Goldney, 2000).
‘In an unconscious attempt to punish themselves, survivors may live permanently with their guilt, convinced that that is what they deserve for having been a bad parent or husband, unaware that much of their guilt is unrealistic’.
How the bereaved person copes with the loss will depend partly on their relationship with the deceased immediately prior to the death (Bowlby 1985; Clark and Goldney 2000). Kast (1988) suggests that guilt feelings will be ‘substantially less if the communication between those remaining behind and the dead had been good, if there had been a genuine leave-taking, and if problems could still be discussed with one another’. Survivors of suicide may have the exact opposite experience. They may have found themselves living with someone who grew more and more unreachable.
It is well documented that anger is a common response to loss (Kubler-Ross, 1969). Anger because the death was preventable or anger at the abandonment. Lukas and Seiden (1987) suggest that in the case of suicide, anger may have 3 elements: “it is a rage at being rejected, at being abandoned and at being accused”. As with general bereavement it may be directed indiscriminately towards family, friends, health professionals, God, oneself as well as at the person who died.Although anger towards the person who died may be the most difficult to access and express, especially when the death is by suicide, as survivors attempt to protect themselves and their memories of the person who died:
‘Grief’s anger has to show its face to be assuaged…guilt is present already and anger can unearth yet more guilt…a violent death compounds the difficulty. Parallel to anger there surges a deep need to idealise the dead….to erect the statue of a saint in place of a flawed human’.
Rejection and insecurity
Suicide can be experienced as a deep affront to the survivor (Wertheimer, 2001). To die by suicide is a rejection of life and therefore a rejection of family and friends too (Silverman, 1994-5).
‘Rejection is unique to suicide bereavement. The differing nature of the sudden death suggests that attachment loss in bereavement situations produces separation anxiety among accidental death survivors, but generates feelings of rejection among suicide survivors’.
Where the relationship between the survivor and the person who dies had been difficult the death may be interpreted ‘as a malicious act with no opportunity for redress’ (Clark and Goldney, 2000). In choosing death it is also choosing the ending of the relationship. Out of rejection survivors may cut themselves off from other people. They’ve been let down once so they may find it very difficult to trust in other people. The possibility of rejection may stop them seeking out others. Survivors may also experience suicide as a rejection of their coping and caring functions and interpret that they were inadequate in their attempts to keep the person alive. Whatever they did was rejected as not being enough. Bereavement such as this can stoke up intense feelings of insecurity. According to Parkes (1998) it can ‘undermine one’s faith in the world as an ordered and secure place’. This insecurity may also be felt in relationships making it hard to trust that the world and those in it will treat them fairly (Lukas and Seiden, 1987) and as a result survivors may hold back from other people.
Social Support / Withdrawal
Although support from family and close friends can have a big role to play in alleviating anxiety, feelings of rejection and depression amongst the suddenly bereaved, studies of suicide survivors have shown that the bereaved report stigmatisation, social isolation and strained relationships (Reed, 1998). In addition Van Dongen(1993) found that many survivors did not access support and found that they tended to withdraw during the months after suicide. In addition feelings of responsibility for the death, guilt, shame and stigma may mean that survivors feel undeserving of help and support and that is what stops them from seeking or accepting support.
Stigma and Shame
A higher level of shame is experienced by suicide survivors than other groups of bereaved people (Silverman et al. 1994-5) although not experienced by all survivors. Shame and stigma is likely to be linked to cultural and religious contexts although shame may also be linked to the survivor’s own feelings of guilt, blame and rejection as well as the associations of suicide with mental illness (Clark and Goldney, 2000). Survivors may feel humiliated and believe that the suicide has brought dishonour and disgrace on the whole family (Seguin, 1995a) and that the stigma of suicide may result in a sense of one’s identity being ‘spoiled’ (Goffman, 1968)which can lead to isolation and feelings of not being ‘normal’.
Seguin (1995) and colleagues interviewed a group of suicide and accident bereaved parents and they found that some suicide bereaved families felt that death had a positive effect; they found that a calm had returned, they no longer had to worry about what might happen. Although nearly a third of survivors interviewed by Solomon(1981)expressed feelings of relief they also had a sense of guilt about feeling relieved. Guilt about whether they were allowed to feel relieved for themselves or whether the relief was for the person who had died.
Suicidal thoughts and feelings are not uncommon amongst the bereaved and may represent a desire to be reunited with the person who has died, to complete unfinished business or linked to depression (Clark and Goldney 2000). However serious suicide attempts and actual suicides are less common (Bowlby, 1985). The feelings may also come from a desire to punish or get even (Wertheimer, 2001). A study by Brent et al (1996b) suggests that suicidal behaviour does run in families. Or they may be more at risk because suicide identifies the vulnerable (Clark and Goldney 2000). Meaning that a family may already be vulnerable because of other problems being present, such as mental illness, other losses or disturbed relationships. During a radio programme on suicide, Colin Murray Parkes said “to some extent, suicide has to be learned” (Wertheimer, 2001). Within the suicide bereaved family what was previously unthinkable and taboo now becomes thinkable. The taboo has been broken and this has become a way of solving seemingly insoluble problems.
In conclusion, although this article highlights common themes it is important to remember “an individual’s grief is as unique as their fingerprint” (Clark, 2000).
Mary Murphy is a career counsellor awaiting her diploma in Humanistic and Integrative Psychotherapy from the Flatstone Institute Cork.
Boakes, J. (1993) ‘The impact of suicide upon the mental health care professional’. Suicide and the Murderous Self. Understanding self-harm as a prelude to effective intervention. London: Department of Mental Health Services, St George’s Hospital Medical School.
Bowlby, J. (1985) Attachment and Loss,Volume III. Loss: Sadness and Depression. Harmondsworth: Penguin.
Bowlby, J. (1982a) Attachment and loss: retrospect and prospect. American Journal of Orthopsychiatry , 664-78.
Brent, D. B. (n.d.) Suicidal behaviour runs in family. A controlled family study of adolescent suicide victims.Archives of General Psychiatry 54 , 1146-52.
Clark, S. E.and Goldney (2000) The impact of suicide on relatives and friends, in The International Handbook of Suicide and Attempted Suicide.Chichester: John Wiley.
Goffman, E. (1968). Stigma: Notes on the Management of Spoiled Identity. Harmondsworth: Penguin.
Grad, O. Z. (1997) Suicide of a patient: gender differences in bereavement reactions of therapists. Suicide and Life-Threatening Behavious, 27, 4: , 379-86.
Hauser, M. (1987) Special aspects of grief after a suicide, in The Aftermath of Suicide. Understanding and Counselling the Survivors. New York and London: W.W. Norton.
Kast, V. (1988) A Time to Mourn. Growing through the Grief Process.Trans. D. Dachler and F. Cairms. Einsiedeln, Switzerland: Daimon Verlag.
Kubler-Ross, E. (1969) On Death and Dying. Routledge.
Lukas, C. and Seiden J. (1987)Silent Grief. Living in the Wake of Suicide. New York: Charles Scribner.
Parkes, C. (1998) Bereavement. Studies of Grief in Adult Life. London: Penguin.
Parkes, C. M. (2009) LOVE and LOSS The Roots of Gief and its Complications. Routledge.
Reed, M. (1998) Predicting grief symptomatology among the suddenly bereaved. Suicide and Life-Threatening Behaviour 28, 3: , 285-300.
Seguin, M. L. (1995a) Parental bereavement after suicide and accident: a comparative study. Suicide and Life-Threatenting Behaviour 25, 4: , 489-98.
Shneidman, E. (1969) ‘Prologue’ in E.S. Shneidman (ed) On the Nature of Suicide. San Francisco: Jossey-Bass.
Shneidman, E. (1993) Suicide as Psychache. A Clinical Approach to Self-Destructive Behaviour. Northvale, NJ: Jason Aronson.
Shneidman, E. (1982) Voices of Death: Personal Documents from People Facing Death. New York: Bantam Books.
Silverman, E. R. (1994-5) Bereavement from suicide as compared with other forms of bereavement.Omega 30, 1: , pp. 41-51.
Soloman, M. (1981) Bereavement from suicide. Psychiatric Nursing, July – September , 18-19.
Toop, D. (1996) The After Life. Vogue , pp. 190-1, 262.
Van Dongen, C. (1993)Social context of postsuicide bereavement. Death Studies 17: , 125-41.
Wertheimer, A. (2001). A Special Scar, The Experiences of People Bereaved by Suicide, (2nd Edition) Routledge.
Worden, J. W. (2003) Grief Counselling and Grief Therapy, 3rd Edition, A Handbook for the Mental Health Practitioner. Routledge.
Zistook, S. (1998) PTSD following bereavement. Annals of Clinical Psychiatry 10, 4 , 157-63.