Bereavement through Suicide ‘Sorrow makes us all children again – destroys all difference of intellect. The wisest know nothing.’ (Ralph Waldo Emerson) The loss of a loved one through suicide can bring intense feelings of grief and mourning. The responses and emotions experienced in bereavement following a suicide can differ from those felt after other types of death. The fact that a loved one's death appeared to involve an element of choice raises painful questions which may not arise if the death was natural or accidental. Bereavement by suicide can be prolonged. The grieving process is characterised by agonising questions and a search for some explanation for what has happened. Research suggests that feelings associated with guilt, shame, rejection and stigmatisation are often more pronounced than in other types of bereavement ¹. Whilst some of the special aspects of bereavement by suicide are described in this section, not all will be relevant to every persons individual experience of grief. Early Grief and Mourning: Shock Numbness Disbelief Searching Anguish and Pining Physical and Emotional Stress Emotions during Bereavement: Guilt and asking ‘If-only’ Anger Blame Rejection/Insecurity/Abandonment Despair Fear Relief Stigma, shame and isolation A Special Grief: Why? Could it have been prevented? Suicidal Fears and Feelings Media Attention Needs of those bereaved through suicide Early Grief and Mourning: Intense shock The sense of shock and disbelief following a death by suicide may be very intense. Recurring images of the death, whether it was witnessed or not, can be a disturbing and common experience after the death. Finding the body can be very traumatic for a person. Reliving the very frightening and painful images of the death, and the feelings these create, is a natural way for the mind to process the suicide. The 'protection' provided by shock gradually wears off and emotional pain begins. Numbness The mind only allows an individual to feel the loss slowly, and so the bereaved person may experience feelings of numbness. What has happened may seem unreal or dreamlike. The thoughts 'This can't really be happening' or ‘I don’t feel anything’ may recur. The numbness of early bereavement may in itself be a source of distress and misunderstanding if one wonders, for example, why one cannot cry at the funeral. In fact, this numbness which may last for days or even weeks, delays emotional reactions and allows the person to get through dealing with the initial practical tasks such as funeral arrangements. Disbelief It is natural to have difficulty believing what has happened. Where a death was untimely and sudden it is even harder to grasp that the loss is permanent and real. On one level it is possible to know that a loved one has died, yet on another deeper level it may seem impossible to accept this as a reality. Feelings of confusion, panic and fear are common during this inner struggle. Searching “Denial is meeting your son on the street, seeing him from behind, the same shaped head, the identical droop of the shoulders, the swinging gait. Your leaping heart cries, "Oh, it's John!" Some days, you'll walk into the house and 'feel' his presence in a room. You can 'see' that smile, 'hear' that laugh. A part of my denial was setting the table for him. Time and again, I'd set his place with all the others and then gasp with the realisation that he would never be coming home to dinner.” - (The experience of a mother who lost her son through suicide) Numbness and shock tend to give way to an overwhelming sense of loss. Many bereaved people find themselves instinctively 'searching' for their loved one, even though they know that their loved one is dead. This may involve calling their name, talking to their photographs, dreaming they are back or looking out for them amongst people in the street. This denial of the painful reality is a natural part of mourning. Realising that a death has really happened and is irreversible takes some time. Anguish and pining The realisation that a loved one is really dead brings with it tremendous misery and sadness. As the loss begins to make itself felt, pining for the person who has died is common. Powerful and desperate longings to see and touch, to talk and be with the person may be felt. The intensity of emotions is often frightening and may leave the bereaved person feeling devastated. Emotional pain is often accompanied by physical pain. It is common to go over and over what has happened, replaying past events and conversations. The need to talk about a loved one, following their death, is part of the natural struggle to counteract their loss. Physical and emotional stress The most common phrase heard from the newly bereaved is, "I feel like I'm going crazy". The pain accompanying the range of emotions can feel so intense that it doesn't seem possible that a normal human being can experience this intensity and still live. The bereaved person may feel they are going insane. They are experiencing the normal physical and psychological reactions to deep loss. Losing someone close is a major source of stress. Restlessness, sleeplessness and fatigue are common. In the initial weeks, people often experience loss of memory and concentration and nightmares including flashbacks are common. Physical symptoms of shock such as dizziness, palpitations, shakes, difficulty breathing, choking in the throat and chest might occur. Intense emotional pain can be accompanied by physical pain. Sadness may feel like an aching pain within. Muscular tension may lead to headaches, neck and backaches. Loss of appetite, nausea and diarrhoea are also common and women's menstrual cycle may be disrupted. Sexual interest may also be affected. The physical effects of shock usually lessen over time. Emotions during bereavement Guilt and ‘If-Only’ Michael* described his terrible feelings of guilt following his brother's death. Not one day had passed that he hadn't asked himself 'Why?' Not one day had passed that he hadn't experienced the tidal waves of guilt that just seemed to drag him under deeper and deeper. Michael agonised over whether they as a family could have done something that might have turned him around, that might have made him want to stay with them. Why, he wondered did they say all those terrible things to each other while they were growing up? Or worse, why hadn’t he said all the things to his brother that he now wished he could? *Pseudonym Guilt and self-blame are common feelings during grief. It can be extremely painful for the bereaved person to accept that they were unable to prevent the death of a loved one or protect them. Feelings of responsibility are common in suicide bereavement and people often judge themselves harshly. The bereaved person may feel, they should be punished, and as a result may hold onto guilt in order to punish themselves. The bereaved person may not be aware that their feelings of guilt are unrealistic. A person’s relationship with the deceased before the death can be a common source of remorse. Sudden death interrupts close relationships without warning. Since our lives are not usually conducted as if every day might be our last, we assume there will always be the future to sort out tensions and arguments or to say the things that have been left unsaid. Regrets often take the form of ‘If only’. Guilt may also be aroused by what the bereaved person may feel or not feel during bereavement such as anger towards a dead person, inability to cry or show grief openly. Occasionally a death may bring with it a sense of relief for those left behind, particularly if there was disharmony and tension prior to the death. This can cause intense feelings of guilt for the bereaved. Lastly, guilt may be felt for surviving, for being alive when their loved one is dead. Anger One woman said that after her son's death she felt great anger towards him for what he had done to her, his younger sister and father. She had often felt overwhelmed with murderous rage, rage at the world, at life, that it could be so unfair, and finally rage at her friends who she once loved and cared for...that they could not be there for her now. Anger is a natural and common response to loss. It can arise from the frustration or bitterness that the death was not preventable or from a sense of rejection or abandonment from the person who died. It is rare to experience grief without anger, and for some people feelings of rage can be very intense. The protest ‘Why me?’ reflects a general sense of helplessness at the unfairness of life, as does anger at others for carrying on with their lives as if nothing has happened. Anger may also have a more specific focus. Intense feelings of blame may be directed towards other people such as relatives, friends or doctors, who did not seem to help the person enough before their death. It is common to feel anger at oneself for 'failing' to prevent their death. Feelings of anger towards the person who has died are often particularly distressing and confusing. As a result, people may tend to deny or suppress anger, yet feelings of anger are normal and often necessary following deep loss. Blame When anger is turned inwards, it can cause feelings of guilt, or it can be directed outwards towards others who can be blamed, in some way, for the loss. Blame can often be directed towards oneself and others at the same time. After a suicide, the bereaved often go over and replay in their minds the circumstances and events of the time before the death, blaming themselves for things they think they should or should not have said or done “If only I had persuaded him to get help” or “If only I had stayed home that evening.” Counselling can provide a safe place to work through these difficult and often conflicting thoughts and feelings. Rejection, insecurity and abandonment It is common to feel abandoned by someone who 'chose' to die. One sister whose brother took his life recalled: "I was upset that he hadn't come to talk to us. I think we all went through anger at some point. You think “How could you do this to us?” People bereaved by suicide may experience a sense of rejection. Some people who are bereaved will react angrily to the implied rejection, but others will feel that this somehow confirms that they are not loveable, not by the deceased and not by everyone else. The possible effects of this include lack of self-worth and self-esteem which should not be underestimated; it can lead the bereaved person to cut themselves off from others, and thus from potential care and support. The possibility of being rejected again and the fear of trusting another may prevent them from seeking out the help and support they need at this extremely difficult time. Suicide may also be experienced by the bereaved as a rejection of their coping and caring skills. They may be left feeling that they are inadequate in some way since whatever they did and however much they tried to help, even that was rejected, and was not enough to keep their loved one alive. When someone dies through suicide, the bereaved person may experience the world as an unsafe place and they can have the feeling that it is only a matter of time before something else goes wrong. Despair Feelings of despair are common during bereavement, once it is realised that despite all the pining and longing, a loved one will not be coming back. It might be difficult to maintain relationships because despair is draining, and interest and energy in others is lost. The bereaved person may be left feeling both powerless and hopeless. Life may no longer seem to make sense or have meaning. Feelings of ‘not giving a damn’ about anything or anyone are common, as is indifference as to what happens to them. In the aftermath of a death suicidal feelings are common. Fear “No one ever told me that grief felt so like fear.” (C. S. Lewis) Fear is common in grief. Confusing feelings, panic and nightmares may make grief a frightening experience. Individuals may fear a similar event happening again. They may fear for themselves and those they love. They may fear 'losing control' or 'breaking down'. Relief People bereaved through suicide may feel relieved that the person who died is no longer suffering mental or emotional pain. However, feelings of relief can bring a sense of guilt about feeling relieved. Even when there is relief, the bereaved person may still want the person back. Unraveling and working through these complicated and sometimes conflicting feelings can be painful and difficult for the bereaved person. Stigma, Shame and Isolation One mother writing about her son's death pointed out that “she had never been told what to say to a bereaved person following a suicide in the family.” What she needed to hear was the same thing that might be said to anyone else who had experienced the death of someone close such as "I'm truly sorry for your pain, is there anything I can do?”,” If you need to talk about it I'm a good listener” or “I've got a good shoulder to cry on." And she needed to know it was really meant. Everyone, she said, believes no one wants to talk about suicide, that it's best left undiscussed, that if you don't talk about it, it will be forgotten and will go away. For her nothing could be further from the truth. Although social attitudes to suicide are changing, they may still limit the support that is available to the bereaved. The silence of others may reinforce feelings of stigma, shame and 'being different'. If others are embarrassed, uneasy and evasive about the way in which a loved one died, the bereaved may be left feeling intensely isolated. Opportunities to talk, remember and celebrate all aspects of a loved one’s life and personality may be denied. A strong need to protect a loved one, and oneself, from the judgment of others may also be felt following suicide. A Special Grief: Why? In any bereavement people will ask ‘Why?’ However, bereavement through suicide often involves a prolonged search for a reason or explanation for the tragedy. Many people bereaved by suicide eventually come to accept that they will never really know the reason why a loved one did what they did. During this search for explanations, different members of the same family may have very different ideas as to why this tragedy happened. This may strain family relationships, particularly where blaming occurs. Although blaming is a spontaneous reaction, it is not rational or fair to assign the liability or responsibility of suicidal behaviour which is a self-intentional, self-inflicted act onto any other person. Could it have been prevented? It is common to go over and over how the death might have been prevented. Reliving what might have been done to save a loved one from suicide is a common experience of the bereaved. Everything can seem painfully obvious in retrospect. The 'what ifs' may seem endless: 'what if I had picked up on that warning comment or sign? or ‘What if I had spent more time with him/her?'. Replaying events and conversations, in one's mind, is a natural and necessary way of coping with the loss of a loved one through suicide. Suicidal fears and feelings Despair is a natural part of the grieving process, but after the suicide of a loved one, a sense of hopelessness may be combined with fear. Identification with someone who has taken their life can be deeply threatening to the bereaved persons’ sense of security. Those bereaved through suicide may suffer more anxiety than those bereaved in other ways and be more vulnerable to suicidal feelings of their own. The bereaved person needs extra reassurance and support. Suicidal feelings can lead the bereaved person to display a complete indifference to death. Some bereaved individuals will behave in self-destructive ways. While not actively suicidal, they may place themselves in dangerous or even life-threatening situations due to the depths of their despair. Media Attention For most bereaved people, grief is a private matter. However, when a loved one has died through suicide or other unexpected causes, it may attract public interest. The inquest that is demanded by law draws attention to the person who has died and to their close relatives and friends. The death and its circumstances may be reported by the media. Attention of this kind can be very stressful for bereaved family and friends, particularly when a death is reported in an insensitive or inaccurate manner. When is it time to get help? Grief is painful and exhausting. It is not always easy to decide at what point it would be helpful to receive some outside support such as contacting your local GP, counselling or support group services. Some reasons you might decide to seek extra help during bereavement are when you: continue to feel numb and empty some months after the death cannot sleep or suffer nightmares feel you cannot handle intense feelings or physical sensations such as exhaustion, confusion, anxiety, panic or chronic tension feel overwhelmed by the thoughts and feelings since a loved one's death such as guilt, anger or rejection have no-one with whom to share your grief and feel the need to do so keep constantly active in order not to feel such as working all the time find you have been drinking or taking drugs to excess find you are worrying and thinking about suicide yourself feel afraid that those around you are vulnerable and not coping