Why is suicide grief unique?

The death of a loved one is one of the most painful experiences a person will ever face, but when the loss is by suicide, layers of suffering are added to the bereavement. The first and most common one is created by guilt, the ubiquitous feeling that haunts practically everyone who goes through this kind of death.

Guilt doesn’t necessarily have to be related to the death itself. Most of the time, it sends the griever back to the last moments before their loss, leaving them in search of all the things that could have been done differently. Suddenly, the unanswered text message from days ago holds a new meaning; the glitches in the relationship don’t seem to be as relevant as they were anymore, and a harsh word said in a moment of frustration makes us feel selfish and unkind.

Anything, big or small, opens the door for guilt to slowly creep in with its unforgiving claws.

Parents are particularly hit by remorse, no matter how involved and dedicated they were to the child they lost. When I interviewed Maria Cristina early this year, her only daughter had died by suicide fifteen years prior. Nevertheless, she revealed to me that she still cries in the shower, tormented by an endless list of ‘what ifs.’

At the time of her death, her daughter Mariana was in her early twenties and had just finished college. Although she had been treated for depression as a teenager, everything pointed to a bright future. Mariana had a boyfriend, with whom she shared an apartment in São Paulo, Brazil, a few close friends, a career in the making, and a mother who was loving and present. Practically every weekend, she would drive an hour and a half to visit her daughter.

Their favorite place was “Liberdade”, a neighborhood in the heart of the city that is a sort of a Japanese version of Chinatown. Mariana loved the Japanese culture, especially their culinary, so they would walk around the area for hours, and then eat at a local restaurant. “She was blooming,” said Maria Cristina. In the week of her death, they had planned to meet on Friday to buy a costume for Mariana so that she could go to a Cosplay party. Her mom postponed it to Saturday because of a massive parade that would happen on Friday, which would certainly block the roads to São Paulo.

On Saturday morning, her daughter’s boyfriend called her saying that Mariana was not home when he woke up, so she immediately drove to her daughter’s apartment, but when she arrived, they had already found her body. Since then, guilt has taken on many shapes and narratives: 'I should have come on Friday, as planned' was the first, albeit not the only one.

The front lock of Mariana’s apartment had been broken for months. Whenever a person tried to open the door, it would get jammed and cause a lot of noise. The last time Maria Cristina visited her, she paid a locksmith to replace it, but instead of feeling good about it, this altruistic gesture became a source of guilt for her. “Maybe if I had not fixed it, her boyfriend would have listened to my daughter adjusting the key when she left early that morning, and maybe he could have stopped her,” she told me.

This is guilt in its purest form. It lingers on, waiting for the perfect moment to sink into a person's life. Guilt has the power to resignify acts of kindness and to destroy even the best of intentions.

Another trait of suicide grief is extreme isolation, which is created by many factors, such as the difficulty in sharing one’s pain, the fear of judgment, the shame, the fact that they may not know how to answer even the most basic questions surrounding the circumstances of death, and the blaming of others.

All these may provoke a personal shut down, a desire to hide from the world, but none is more central to isolation than the stigma that surrounds self-inflicted death. This inescapable reaction of others is maybe the most central element that constitutes the singularity of suicide grief, as Maria Cristina recalls:

“On the day of the funeral, several friends invited me to get together, but after that, I never heard from them again. I think they felt uncomfortable and didn’t know what to say to me. I’m not even included in my extended family’s gatherings anymore. Many of the parents I meet tell me the same thing, it’s pretty common,” she said, referring to members of the support group she attends weekly, in her hometown.

In the book Myths about suicide, the author Thomas Joiner argues that losing a loved one to suicide is frequently followed by a profound change in one’s address books “once trusted friends fall away after ignoring a loved one’s suicide or after saying hurtful and appallingly glib things like ‘It was God’s will.’” And it can even be more wounding than that. A few weeks after my father’s suicide, my younger sister was told that because of what he had done to himself, my dad would be in a horrible place for a very long time.

To avoid this type of remarks, many families choose to deny the suicide altogether by either engaging in lies or self-denial. Maria Cristina told me that she used to participate in an online grief support group for mothers. One of the members had lost a son to suicide but refused to disclose the truth. Every time she talked about it, the woman would mention a car accident as the cause of death. Maria knew it wasn’t true, but she kept it to herself. “One day, when I felt strong enough to share with them my daughter’s story, I was instantly blocked from the group, and couldn’t communicate with them anymore,” she added.

These are just some examples of what makes suicide bereavement singular. Unfortunately, there are many others. The bottom line is:

With each token of rejection, the bereaved retreats in his pain, and it is by avoiding friends and family members that he perpetuates the pernicious cycle of silence.

What should I do if a friend is contemplating suicide?

In my previous post, I talked about warning signs, so the natural question after that is: what should I do if I believe that someone is thinking about suicide?

The first thing to do is to be direct about it. No beating around the bush. There is a myth about suicide that if you bring it up you could put the idea in someone's head. The opposite is true. Being open about it will possibly bring relief to the person. When this is done properly, that is, without judgment, this attitude will help validate what they are feeling. I have seen it happen firsthand.

One day, I received a call from a friend that I had not seen for a while. At the time, the theme of suicide was quite familiar to me. I had already published my book and knew of the warning signs, so a few minutes talking to her were enough to sense that something was off. I can’t recall what she said, maybe it was the sound of her voice, but I remember what I did. “Are you calling to say good-bye to me? Are you thinking about suicide?” I asked.

She burst into tears and explained all the details she had carefully prepared so that she could end her life the following week. After listening to her for a long time, I assured my friend that although I could never truly know what she was feeling, I could tell that she saw no way out of her situation. This is relevant because a suicidal person often has a constricted view of the problem. Their sense of hopelessness interferes with their perception. By acknowledging that, you build a solid foundation to start a constructive dialogue.

The next step is to try to identify where they are in terms of planning. Think of self-inflicted death as a continuum that starts with thoughts, which can be situational or frequent, and moves toward ideation, attempt and completed suicide. Being able to determine in which stage the person is will define the type of intervention needed.

My friend had already bought a lethal amount of medication, a ticket to a city far from where she lived and had a day and time set for the attempt, so I knew that it was an emergency. At the same time, I felt that after we talked, she was more serene and calm. I asked her to give me a chance to set up an appointment with a psychiatrist, and three days later, she was diagnosed with depression.

Most suicides are associated with a mental disorder that is either inadequately treated or remains undetected. In her case, I could see many symptoms of depression, so it seemed the best course of action at the time. This happened eleven years ago. She is still alive and well.

Be proactive. Many times, after listening to someone who is in distress we say things like “if you need to talk to someone, call me” or “I’m here in case you need a friend.” Instead of waiting for them to take the initiative, do it yourself. Be present. Send a text, call them, show them you mean it. Pain immobilizes people. They may be feeling alone or thinking that no one will understand what they are going through, so if we keep a distance, we may validate this belief.

Try to broaden their support system.

Nothing is more healing than feeling loved.

Involve friends, family members - with consent -, mental health services (in schools and colleges, for example), and religious communities, if that’s the case. Helping a suicidal person is an extremely stressful task. No one should do it alone.

Finally, a few tips on what to avoid:

• Right and wrong statements, like "You shouldn’t” or "That's not true.”

• Even if you feel shocked, try not to show it because it can keep the individual from opening up.

• No clichés, such as "you have everything to live for” because it can reinforce the shame and guilt they are probably already experiencing. The same applies to statements like "You will hurt your family," "Suicide is for cowards," or "Suicide is the easy way out.”

And remember:

Self-preservation is the most primal of human instincts, so any inclination toward self-inflicted death must be taken seriously. 

Do suicidal people exhibit warning signs?

Every time Davis and his mother Marcia said good-bye to each other, they performed a simple ritual: it started with her saying “God be with you, son. Your mom loves you,” to which he would reply “me too.” They would smile with affection and part. But on that day, he did something different. Before leaving the car, Davis looked at her and, without waiting for his mom’s words, he said “Mom, I love you very much,” and left, hastily. The following day, Marta received the heartbreaking news of his suicide.

This is what suicidal people do. They behave out of tune. They scream at us - many times through silence - in an effort to express their internal pain. It may come in words, in gestures, in mood swings, in risky behavior, or isolation. Davis tried all of them. Marta told me about problems in school during his early teens, the excessive partying later on, the drugs most of his friends used, and the numerous girlfriends he had in his youth. Sounds like a normal young man trying to find his own identity, right? Not quite.

Apart from interviewing the mother, I also talked to his younger sister, Mayra. I often try to get more than one version of a story because it adds depth and gives a clearer sense of what happened. In this case, it provided insight into what was going on in his life. More importantly, it made it possible for me to trace the warning signs he had exhibited before his death.

According to Mayra, at the age of 14, Davis had a car accident right after his girlfriend ended the relationship. Later, they found a letter in which he had written: “I wish I could vanish from this world.” This made it clear to the family that crashing onto a tree had been an intentional act.

Being able to identify warning signs can be very hard, even when they are verbally communicated. Minutes before leaving the car and saying “I love you, mom,” Davis told his mother that the constant arguments he was having with his wife would sometimes make him wish to... (he completed the sentence by moving his hand across his neck as if he were cutting it open with a knife).

She asked him directly if he was contemplating suicide, and he said: “yes, at least I would stop causing problems to everyone.” Marcia asked him to be patient because, with time, the arguments would pass. Today, she plays this scene in her mind over and over again, asking herself what she could have done differently.

by Noah Silliman

Research shows that most people who die by suicide express their wish one way or another, but we are unable to either notice these warning signs or to assess their risk level. Apart from the verbal ones, which are more easily identifiable, such as “I want to disappear/die,” “life has no meaning anymore,” or “I am a burden,” these messages are often expressed by changes in behavior, mood, and appearance. In a way, they are similar to symptoms of depression: isolation, lack of hygiene, sadness, substance use, sleep dysfunction, mood swings, irritation, lack of pleasure, and apathy.

When it comes to suicide, some specific warning signs represent red flags because when present, they usually mean that the individual has advanced from thoughts to effective planning. This happened with my father, but again, we were only able to see it in retrospect. The day before his death, he paid my sister a visit. She could tell that there was something wrong with him. Every time she mentioned that I would return from vacation in a few days, he would reminisce about a trip we had taken together a few years prior. When a person decides to take their own life, they stop making plans because they ‘know’ that there is no future ahead.

Suicidal people talk about the past because, for them, there will be no tomorrow.

Apart from reminiscing, they organize practical things, especially finances. They pay debts, open joined accounts so that someone else can access their money, discuss the will, etc. The idea is to leave no hurdles for the family. Saying good-bye is also common. They call old friends, family members, and pay unexpected visits to loved ones. I had this experience. One day, a friend called me and I could immediately tell that she wanted to talk to me for the last time. I asked her directly: “are you thinking about suicide?” She fell silent for a few seconds, then burst into tears. It turned out that she had everything planned for the following week.

Another red flag should be raised when the person starts to give away possessions, particularly those with sentimental value. By doing this, they are sending the message that nothing else has value anymore.

Finally, there is one warning sign that frequently baffles those who are left behind: the apparent improvement of symptoms. Time and time again, I have heard mourners say “but he/she seemed to be doing much better.” It may sound like a contradiction, but it actually makes sense. The reason behind the sudden change in mood - when depression seems to be in remission, for example - is the fact that there is no more internal conflict, the ambiguity is gone, therefore, the individual does feel better. The angst is lifted, and as a result, they convey the misleading impression of recovery.

The question is: what should you do in case you identify the signs in someone you know? I will explore this theme in more detail on a future post, but the basic thing to do do is to address it in a straight forward manner. Ask if they are thinking about killing themselves. Try to assess where they are in terms of planning. This is very important because it will define your course of action. Build a support system, in other words, don’t do it alone. Involve other people and, if possible, family members. Finding a doctor may be also important because many suicides are related to mental illnesses that are either undiagnosed or remain untreated.

Finally, one of the most important things to keep in mind is: don’t judge their thoughts and actions. You can’t possibly know what they are going through. Judgment feeds the shame they are likely already experiencing. By doing that, you will make them feel even worse. And remember:

Suicide is rarely associated with a wish to die; it is primarily a desire to put an end to unbearable pain.