Thirty thousand Americans die by suicide annually. “Nearly 750,000 people a year are left to grieve the completed suicide of a family member or loved one, and they are not only left with a sense of loss, they are left with a legacy of shame, fear, rejection, anger, and guilt” (Worden, 1991, p. 93).
To understand the grief response of suicide survivors, one has to explore how society has treated them historically. The issues related to their type of grief come from a history of shame and social outcast. In 18th Century Europe, the suicide victim’s body was dragged through the streets. Some were decapitated, thrown to wild beasts or hung upside down. The body, denied a proper burial, would usually be placed in a sewer or brought to the side of the road with a stake through the heart and covered with stones. In addition, survivors were forced to leave their home without goods or property. Berman & Jobes report that “Property, title and goods of the deceased would all be forfeited to the King, and law would decree that there would be no memory of him.” In 18th Century England, trials were held posthumously to decide whether the victim was insane, and therefore innocent. Survivors would then shoulder less blame and punishment. Even with this verdict the survivors would still be burdened with shame and social stigma of their family member being insane.
In the 19th Century, suicide was believed to be caused by genetic influences. They marked the survivor’s name and their property values were lowered. Though they dismissed the genetic influence theory by the 20th century, the stigma remained. Berman & Jobes (1997) report:
In response, survivors attempted to conceal the suicide, hastily arranged funerals, and kept the truth from children. Suicide became the family secret, the neighbor’s gossip, and a source of blame and public shunning. Survivors were thus doomed to their own private shame-trapped with their feelings of hurt, loss, and anger (p.246).
In the 1960s, the study of survivor grief and postvention found that survivor stigmatization still existed. Schneidman (as cited in Lester, 1993) defines suicide as “a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which suicide is received as the best solution” (p. 114). The death profoundly affects the family and friends of those who find this solution their only alternative. Studies indicate that witnessing the suicide or finding the body of a loved one is likely to result in post-traumatic stress reactions. Even in the absence of being a witness or discovering the body, the death is a traumatic event in the life of the survivor. The act itself is unnatural and sudden. The individual caused his own death and the family must deal with the unexpectedness of the situation. They are faced with police investigation of this self-killing. As the survivor experiences shock, this police activity compounds the pain the survivors feel as the death surround is explored. Barraclough & Shepherd’s and van der Wal & Cleire’s studies (as cited in Cleiren & Diekstra, 1995) report, “The investigation, especially in the case of uncertainty about suicide or murder, may be lengthy. When not conducted carefully, this may be a source of intense stress for the bereaved”(p. 15).
Many suicides take place in the home. The physical remains of the suicide may still be present in the home requiring the family to clean up blood and/or bone fragments as well as having to plan a funeral. Van Dongen (1991) found that 11% of his subjects reported having recurrent episodes of discovering the victims body in their sleep and during the day. Following these episodes, which could last from 15 to 20 minutes, the subjects reported feeling totally exhausted and unable to resume their daily routine.
Initially society blames the survivor and offers less grief support than it does for survivors of a natural death. Survivors may set themselves apart from those around them because of the blame, rejection and lack of understanding on the part of society. Friends, neighbors and co-workers are at a loss for words and often say nothing, or their words are those of blame. The survivor, in order to cope, may refuse to discuss the death or create different circumstances surrounding the death. They may not be able to accept the reality of the death, maintaining denial and disbelief. Searching for the deceased is a frequent way for one to protect their denial.
Calhoun and Allen (1991) found suicide survivors tended to be more psychologically disturbed, less likable and more blame worthy than nonsuicidally bereaved. McNeil, Hatcher and Reuben (1988), in their study of widows, write that widowed suicide survivors reported less intimacy with those around them and guilt. They also report receiving more blame from those around hem than did the nonsuicidally bereaved widow.
Barrett and Scott (1990) found four grief reactions unique to suicide survivors. Those that:
- Normally result from the death of a family member, irrespective of the cause along with somatic symptoms, sense of hopelessness, feelings of anger and guilt, a loss of social support, and an increase in self-destructive tenancies;
- Usually arise from a death whose cause is deemed not to be natural and is perceived as avoidable, including feelings of being stigmatized, abandoned and shamed by the death;
- Usually arise from an unanticipated death despite the cause, including shock, search for an explanation of the death, feeling responsible and blamed; and
- Result from the additional trauma of dealing with the suicidal nature of the death, including feelings of rejection.
Compounding the problems of coping with a suicide death is the complex nature f the emotional relationship that existed between the deceased and others prior to the death. The victim’s mental illness may have caused a gap in his/her relationships and often the family would withdraw from a helping role. When the victim was suffering from mental illness or physical pain that caused undue stress upon him/herself and the family, the survivors dealt with issues of renewal and freedom. Therefore, the relationship the survivor had with the victim before the death is an indicator as to how there was absolutely no indication her/his loved one would die by suicide, the grief response was very intense. If s/he saw some intent, then the grief response would be less. Cleiren’s study, found that “in suicide-bereaved families, we find patterns of emotional relationships with the deceased before the loss that are markedly different from those in other bereaved. The suicide bereaved tend to look back on the relationship with the deceased as being less intimate, less satisfactory, and more ambivalent, whereas they viewed the deceased as having been more dependent on them” (Cleiren & Diekstra, 1995, p.17).
Reed and Greenwald (1991) found that the attachment and kinship relationship becomes a grief response that they refer to as “survivor-victim status.” The authors’ found that attachment was more important than kinship relation in the intensity of grief. Higher levels of attachment significantly increased guilt, shame and mental preoccupation of the death for both death and accidental survivors. Survivors of suicide experienced greater guilt, shame and rejection than accident survivors; however,, they reported less shock and emotional distress than the accident survivor group. Subjects in the suicide survivor group said they always knew something like this would happen, just never believed that it could. The relationship they shared could have been one of frustration. Some survivors emotionally withdrew from their loved one prior to the suicide. The emotional withdrawal may lead to a guilt reaction after the suicide.
The difference between suicide and nonsuicidally bereavement is the intensity rather than the type of bereavement. But, even this concept is not without some disagreement. Cleiren & Diekstra (1995) report that most comparative studies do not find the suicide survivor experiences more guilt. McIntosh and Kelly (1992) report there are more similarities than differences in the grief response among suicide, accident and natural death survivors. They did not find any guilt or social support differences. They did find that suicide survivors differed from others in three ways. They blamed more people, felt stigmatized, and felt they could have done something to prevent the suicide. However, in a study of family experiences after a suicide, Van Dongen (1991) found that feelings of guilt were present and brought on by thoughts of how the survivors may have inadvertently contributed to the death and/or what they might have missed in recognizing the deceased’s intent.
Demi (1984) earlier concluded in a comparative study of suicide and non-suicide death bereavement that there were no differences in social adjustment although survivor of suicide reported more guilt and resentment. In addition, Demi reported that preoccupation with the question of responsibility is more prevalent among suicide survivors.
Miles and Demi in their 1991 study of parental grief and the guilt responses of parents who lost their children by suicide, accident or chronic disease, the authors found that 92% of the suicide survivors reported guilt. Although all three groups reported high levels of guilt, only the survivors of suicide listed guilt as the most distressing factor. The cause of death was also a factor with 63% of the suicide survivor parents reporting death causation guilt. The belief that actions performed or not performed by the parents contributed to their children’s suicide was very prevalent in the group of suicide survivors.
Suicide survivors’ beliefs influence their grief process and these beliefs sustain them as they find meaning in the loss. Survivors are at a loss in explaining the meaning, and therefore may offer other explanations. Many survivors search for meaning through support groups, reading about suicide and mental illness. Many block thoughts relating to suicide all together. The bereaved are hurt that their loved one ended his/her life. The sadness at times is overpowering. Months and even years later, survivors experience a tidal wave of emotion dealing with the suicide. These upsurges of grief can happen long after they thought they were finished with grieving. Anything may trigger the upsurge, a picture or a sad song may bring back an intense feeling first experienced right after becoming aware of the death.
The bereaved may search for clues that caused their loved one to die. This searching may result in extreme psychological suffering on the part of the survivor. Cleiren & Diekstra (1995) describe the depressive psychiatric history of many suicide bereaved. This history is often accompanied by feelings of powerlessness or helplessness. The survivor may conclude that s/he is a failure, s/he failed to save the life of this special person in her/his life. As time goes on, survivors may come to accept the idea that there are no real answers to the question of why their loved one completed suicide.
Anger is a normal grief response. In studies describing the suicide survivors anger response, this anger is most often directed at the victim, the mental health system, or at the survivors themselves for not seeing the signs, or for seeing the signs but not being able to save the deceased. Survivors may also be angry with a society that stigmatizes them. Anger is an integral part of the questioning process a process that is very significant to the survivors. Silverman, Range and Overholser (1994) found that suicide survivors were more likely to blame themselves. They were also more inclined to risk their health in self-destructive behaviors. These findings confirmed what other researchers have found – that is survivors feel more anguish in searching for an explanation of the suicide, have higher levels of shame, and feel more rejected and betrayed then other groups.
As a survivor mourns, s/he relies on rituals, especially those that allow for sharing. All bereaved are helped in their healing by rituals. Suicide studies, however, find that morning rituals for the suicide survivors are compromised by a notable black of social support. This lack of support kindles the denial, sigma and shame survivors feel. Their belief system is shaken to its very core. Many even feel the stigma within their own religious affiliation. Many ministers and priests may refuse to participate in the usual burial services practiced within the religious group. One may deny burial in a church-approved cemetery (Lester 1989).
Of all the feelings suicide survivors experience, one of the most predominant feeling is shame, Surviving spouses of s a suicide are viewed as more the blame, more likely to feel ashamed of the cause of death and more likely to have been able to prevent the death than a person widowed by an accident or illness (Lester, 1993).
Rejection is also more common in survivors than any other bereaved group. Survivors feel rejected by the victim resulting in difficulty in trusting others or committing to relationships.
The research cited shows some inconsistency in the description of suicide survivor grief.
- Is the grief response significantly different from that which is seen in the grief caused by all other causes of death?
- Are the feelings of guilt, blame, shame and anger more prevalent and or more intense in the suicide survivor?
One reason for the lack of consistency may be found in the lack of valid and reliable research tools needed to come to some universal and consistent answer. Doka (1996) addresses this issue when he writes:
Historically, there has been little systematic study regarding the effects of suicide on survivors. At least three reasons for the dearth of research have been suggested. First, it has been difficult to identify samples of suicide survivors large enough to be representative of the total population of those bereaved by suicide. Second, few valid and reliable tools have existed for examining differences between those bereaved by suicide and those bereaved by accidents or illness. Third, many researchers have felt uncomfortable asking survivors about their feelings following suicide, fearing that such questions would intrude on their privacy or prolong their grief by making them revisit the pain involved in such sudden, unexpected and perhaps shameful death (p. 42).
Writing this article provided me with the opportunity to confirm what I already knew as a suicide survivor, and that is, with most certainty, survivor grief is disenfranchised and the questions of “why” last a lifetime.
References
Barrett, T.W. & Scott, T.B. (1989). Development of the grief experience questionnaire. Suicide and Life Threatening Behavior. 19(2), 201-213
Berman, A. & Jobes, D. (1997). Adolescent Suicide Assessment and Intervention. Washington, DC: American Psychological Association.
Calhoun, L.G. & Allen, B.G. (1991). Social reactions to the survivors of a suicide in the family: A review of the literature. Omega, 23(2), 95-97.
Centers for Disease Control (1986). Youth suicide in the United States, 1970-1980. Atlanta: Department of Health and Human Services.
Cleiren, M. & Diekstra R. (1994). After the Loss: Bereavement after Suicide and Other Types of Death. In Mishara, B. (Ed.), The Impact of Suicide. (P.15). New York: Springer Publishing Company.
Danto, B.L. & Kutscher, A.H. (Eds.) (1977). Suicide and bereavement. New York: Arno Press.
Demi, A.A. (1984). Social adjustment of widows after sudden death: Suicide and nonsuicide survivors compared. Death Education, 8, 91-111.
Lester, D. (1989). Questions and Answers about Suicide. Philadelphia, PA: The Charles Press.
Lester, D. (1993). The Cruelest Death, The Enigma of Adolescent Suicide. Philadelphia, PA: The Charles Press.
McIntosh, J.L. & Kelly, L.D. (1992). Survivors reactions: suicide vs. other causes. Crises, 82-93.
McNeil, D.E., Hatcher, C. & Reuben, R. (1988). Family survivors of suicide and accidental death: consequences for widow. Suicide and Life-Threatening Behavior, 18(2), 137-147.
Miles, M.S. & Demi, A.S. (1991). A comparison of guilt in bereaved parents whose children died by suicide, accident or chronic disease. Omega, 24, 203-215.
Moos, N. L.. (1995). An Integrative Model of Grief. Death Studies,19,(4), 337.
Pritchard, C. (1996). Suicide – The Ultimate Rejection? A psycho-social study. Bristol, PA:Open University Press.
Reed, M. & Greenwald, J. (1991). Survivor-victim status, attachment, and sudden death bereavement. Suicide and Life Threatening Behavior, 21(4), 385-401.
Renaud, C. (1995). Bereavement after a Suicide: A Model for Support Groups. In Mishara, B. (Ed.), The Impact of Suicide. New York: Springer Publishing Company.
Silverman, E., Range L. & Overholser, J. (1994). Bereavement from suicide as compared to other forms of bereavement. Omega, 30(1), 41-51.
Stillion, J.M. (1996). Survivors of Suicide. In Doka, K.J. (Ed.), Living With Grief After Sudden Loss: Suicide, Homicide, Accident, Heart Attack, Stroke (p. 42). Bristol, PA: Taylor & Francis.
Van Dongen, C. J. (1991). Experiences of Family Members After a Suicide. The Journal of Family Practice, 33(4), 375-379.
Werth, Jr., J. L. (1996) Rational Suicide? Implications for Mental Health Professionals. Bristol, PA: Taylor & Francis.
Wrobleski, A. (1984). The Suicide survivors grief group. Omega, 15(2), 173-183.
Worden, J. (1991). Grief Counseling & Grief Therapy. (Second ed.). New York: Springer Publishing Company.
