Friday, July 30, 2010

Complicated Grief: Surviving Suicide

This is the second in a series on complicated grief. The first post in this series explored the challenges of surviving perinatal loss. Today, I'll be exploring how the suicide of a loved one can also lead to complications in the grieving process.

Defining Complicated Grief
Complicated grief is grief that is triggered by a loss that is out of context with normal, developmental losses. For example, the death of a parent when you are in your 60s is a painful event, and it is developmentally appropriate. The death of a parent when you are in your 20s is unexpected and out of context, so your experience of grief may be more traumatic. Another indicator of complicated grief is that the normal emotions of grieving (e.g. sadness, denial, anger) may be felt with greater intensity or may last longer than expected. Finally, complicated grief can occur in situations where the loss has a negative effect on your social support system.

Surviving Suicide
The term "suicide survivors" is often used to describe the immediate family and close friends of those who have committed suicide. This term may also include care-givers or others who are connected to someone who completes a suicide. Sometimes, the family and friends of a person who attempts suicide, but does not complete it, may have parallel experiences. Suicide survivors often experience all the components of complicated grief.

Loss Out of Developmental Context

Everyone knows that they will lose loved ones to death. These losses can occur in multiple ways. A loved one can die of cancer, heart attack or other illness. They might die in a car wreck or other accident. They may even die of old age. However, with all of these types of death, people who are left behind are able to understand that their loved ones did not choose their deaths.

The primary feature that sets deaths by suicide apart is that suicide is ultimately seen as a choice. Even the language used to describe suicide (e.g. "committed suicide") implies the element of choice or control exercised by the person who died. The sense that "they chose to leave" is a primary feature that places loss by suicide outside of the normal developmental context of loss.

Emotions of Greater Intensity

The same feature that sets suicide loss outside of the normal loss context is a primary reason that many suicide survivors experience their grief emotions at higher intensity. When it feels as though a loved one has chosen to die, to leave, that can strengthen the intensity of emotional reaction.

Some survivors of suicide deal with very strong denial. They cannot bring themselves to accept that a loved one's decision was a choice. You may feel the need to find an external source of blame. They may also cope with the loss by focusing only on the good memories or the strengths of their loved one. When asked about feeling angry or abandoned, they may react strongly in defense of the person who committed suicide.

Many suicide survivors also struggle with guilt and unanswered questions. They may feel as though they should have "known" or "done more." Even if their loved one left a note, most survivors of suicide have additional questions about the motivation behind that decision. The guilt can be nearly paralyzing, as they struggle to understand a decision that makes no sense to them.

One of the most challenging emotional experiences for suicide survivors is anger. While anger is a normal part of our grief emotions, anger after suicide is often more complicated. Anger after a suicide may be directed at ourselves for "not knowing." Self-directed anger may be complicated by guilt. It may be directed at a third party (case manager, school, etc.) because they did not prevent the suicide. But the most difficult level of anger is the anger survivors may feel is anger at the loved one who committed suicide. For many suicide survivors, this anger is so intense that it can feel like it entirely wipes out the memories of positive parts of the relationship (at least in the short term).

Challenges with Social Support
Surviving suicide can be also be difficult because survivors may not feel able to utilize their normal social support network. This can happen for several reasons.

When one member of a family has committed suicide, the rest of the family may struggle with openly sharing their pain within the family. Family members may be dealing with different emotions at different times. Survivors may be sensitive to "upsetting" one another by talking about their pain.

Because suicide is viewed as a choice, there is a lot of social stigma around discussing death by suicide. This stigma can impact social support in several ways. Some friends or family may not know how to address the suicide, and so may appear to be unaware of survivors' pain. They may choose not to discuss their loss because they are protecting the memory of their loved one--survivors do not want them to be remembered or judged by that single choice.

Finally, the intense emotions that many suicide survivors face may make it difficult for them to get support from their normal social support network. Survivors may be concerned about overwhelming those around them. They may be worried about how feelings of guilt, anger, or loss may reflect on their loved one. Survivors may simply not have the words to describe what they are experiencing.

Getting Support

Losing a loved one to suicide can create complicated grief. It is important for survivors to find the right type of support as they navigate the challenges of being a suicide survivor. Whether seeking individual therapy, family therapy, or a survivor support group, many suicide survivors benefit from being able to explore all the components of their grief in a safe, supportive environment.

If you have survived the suicide of a loved one, or are concerned that someone you care for may be at risk of suicide, here are some resources:
Suicide Awareness Survivor Support
International Association for Suicide Prevention
Books by and for Suicide Survivors

Please reach out for any support you need!