Bereavement after suicide shares characteristics with other types of bereavement, yet it is also different. Understanding how and why it differs is helpful when supporting people who have suffered a loss from suicide.
The grieving process is often complicated and typically lasts longer than other types of bereavement –with significant effects still being felt many years after death by suicide. As individuals, each person will have had a unique relationship with the deceased so it’s important to understand that there is no single or right way to grieve – or resolve grief. Despite the different ways we might respond, there are some common reactions. Factors that make bereavement different for the suicide loss survivor include:
- Circumstances of the loss
- Emotional and physical reactions
- Post Traumatic Stress (PTS)
- Survivors’ questions
- Stigma and isolation
- Family and relationship tensions
- Other prejudices
- Lack of privacy
- Investigations
- Practical Concerns
- Religious and spiritual beliefs
Circumstances of the loss
A death by suicide is usually sudden, often unexpected and may be violent or physically disturbing. These factors increase the degree of shock and trauma experienced compared to many other types of bereavement. Survivors may struggle to make sense of what has happened and fundamental beliefs may be challenged, or even abandoned temporarily or with some permanence.
Emotional and physical reactions
Bereavement by suicide can bring an intensity and range of emotions and physical reactions that may be unfamiliar, frightening, and uncontrollable. Emotional reactions are often complex and people may find that they are experiencing a swirling range of feelings from guilt, anger, and shame to rejection, sadness, and fear. People who have been bereaved by suicide may become vulnerable to thoughts of suicide themselves, or experience periods of sustained or situational depression.
Physical reactions may include tightness in various body parts, stomach pains, sleeplessness, social anxiety, loss of appetite, agitation, and poor concentration at work or school.
Post Traumatic Stress (PTS)
Those who have been bereaved by suicide may have symptoms of post-traumatic stress. If the person witnessed the death or found the body, they may suffer from flashbacks or nightmares. This can also happen even if the person did not see them but cannot stop imagining what happened. Imagination may sometimes be worse than the reality.
Survivors’ questions
Most people bereaved by suicide are haunted by two questions: “Why did the person take their life?” and “Could I have somehow prevented it?”. These can be impossible questions to answer and eventually the person may have to either accept that they will never know or settle on an answer that they can live with. A suicide note may provide some clues but may also raise new questions and add to a survivor’s stress or pain.
It is natural that the bereaved person will take some considerable time exploring their questions; it is an important part of the grieving process and the loss survivor’s journey. However, it can also be damaging if they are unable to reach a stage where the questions occupy less of their thoughts or if they cannot find an answer they can accept. Self-esteem, confidence and hope can be severely compromised if the griever becomes stuck in a ruminating cycle of questions that cannot be met with some acceptance.
Stigma and isolation
Even more than other types of bereavement, death by suicide makes many people uncomfortable and unsure how to react. There is still a stigma attached to suicide, rooted in centuries of history and this generates misplaced associations of weakness, blame, shame or even sin or crime. This stigma often prevents people from seeking help when they need it, and others from offering support when they want to help.
There may be a desire to deny that the death was a suicide –this may be driven by cultural values or from a sense of denial or of shame. This can create further confusion in an already complex situation.
Many people who have been bereaved by suicide find that they feel isolated. Others may avoid them, perhaps not knowing what to say or because they don’t want to upset the person. The sense of isolation may be especially acute if the bereaved person perceives other people to be uncaring or judgmental. Some people may even be subjected to particularly thoughtless or insensitive comments.
It may also be that the bereaved person avoids contact with others. They may struggle to share their own feelings because they are fearful of what they are experiencing, they don’t want to upset other people or they may worry about how to answer questions such as “how did they die?” Like other bereaved persons, suicide loss survivors often feel the weight of “the elephant in the room” – whose presence is uncomfortably felt and ignored at the same time.
Family and relationship tensions
While family and friends are often a great source of support, they can also be a source of tension and conflict. Sometimes families struggle to communicate, protective instincts arise and they may be worried about causing more pain or about having a different view or feeling from others. Because the range of feelings and emotions experienced after a suicide can be so unfamiliar and frightening, people may be uncomfortable or scared to share. If shame is an issue, the bereaved may worry about what others are saying either publicly or privately.
Existing tensions and difficulties in family relationships can surface as a result of the shock and trauma of suicide. Some people cope with their pain by blaming another person (inside or outside of the family) for the death. This may go as far as excluding them from the family, denying them the opportunity to attend the funeral and withholding information about the investigation. This can lead to huge rifts and a deep sense of hurt and isolation being added to the loss.
Other prejudices
There may be other factors that create additional stigma. These may be biased attempts to explain why the suicide happened and can result in speculation and blame. Prejudicial comments or attitudes can feel judgmental and cause the bereaved to feel more hurt, upset or isolated.
Lack of privacy
When someone dies by suicide, it can be difficult to maintain privacy. There may be emergency services at the scene and visits from law enforcement if the suicide is being treated as a possible crime scene. In some instances, there maybe unwanted media attention. If the suicide becomes a matter of public interest, there may be reporting or omissions in reporting that remain on publicly accessible databases.
Investigations
An investigation by a medical examiner or coroner can be a source of relief or concern for those bereaved by suicide. The process may take time and some aspects may require legal and technical explanation. If the suicide is of public interest, there may be some reporting related to the investigation. There may also be additional investigations if the death happened while the individual was under the care of another agency e.g. in prison or if they were receiving mental health treatment. Investigations may also reveal information about the deceased person that was unknown to their family and friends.
Practical Concerns
There are other practical concerns such as funerals, finances, returning home, adjusting to a new family structure, and returning to work that the bereaved will need to face. Support groups and counseling can help greatly in the aftermath of a suicide. Loss survivors report that listening to or talking to others, who’ve been through similar situations and are coping with suicide, have been a form of life support and a bridge to navigating life anew after a suicide loss.
Religious and spiritual beliefs
It is important to be culturally sensitive to religious and spiritual beliefs of the deceased and the bereaved, which may be the same or different. Rituals and beliefs can be a great source of comfort to the bereaved, yet in some instances they might present challenges related to suicide to be addressed.