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HELP FIGHT THE STIGMA

© 2019 by Paula Fontenelle

By Danielle McInnes

The pain of losing a loved one to suicide is recognized as one of the hardest to endure. Apart from dealing with the natural emotions provoked by death, such as sadness and disbelief, the bereaved are faced with conflicting emotions and, many times, external rejection.​

When a person dies by an accident or disease, family members are surrounded by friends who ask questions and offer support. This is not necessarily true with suicide. The very idea of a person 'choosing' to end their life is an unspeakable act that silences those touched by it. The impact it has on grievers is gradual isolation. Grievers don't know what to say either because they are themselves struggling to find answers.

Guilt and Shame

 

In the aftermath of suicide, two questions haunt those who are left behind: why and what if. Both lead to guilt, the most common response to self-inflicted death. In the search for answers, the bereaved often replay the last moments they shared with their loved ones in an attempt to find undetected warning signs that they could have seen and done something about. This is when the "I shoulds" appear in full force. This reaction is compounded by the fact that other people do the same, particularly when it comes to family members. The question 'how could they not see it', hovers over parents, siblings, and partners. Many times, these words are never actually verbalized, nevertheless, it's present in the family's perception of how they are viewed by others.

 

Guilt comes in many forms. Even when the person feels that they had done everything they could, it is common to hold on to specific moments of disagreements or what they perceived as 'not being there'. A son might have taken care of his mother for months, for example, but still blame himself for that one day he could not stop by to check in on her. In the face of suicide, there is always room for regrets.

Blaming self and others is one of the natural faces of suicide grief but it can lead to the destruction of relationships and further isolation. In the midst of anger, the bereaved point their fingers at friends, romantic partners, authority figures, medical and mental health professionals, and institutions. This can be an attempt to project one's own guilt or simply a way to fill the void created by the 'why' question. In a time when love and support are the most helpful sources of healing, in families, this attitude can have devastating, long-lasting effects. It creates a destructive vicious cycle: the individual feels guilty, then blames someone else for the loss, which disrupts the relationship and creates further isolation. Alone, they will bury thoughts and feelings, which will induce even more guilt and blame. 

Anger

 

In other types of death, anger is present, but in suicide, it feeds shame and guilt because mourners will not only direct it to themselves and others but oftentimes, at the person who died. The origin of such displacement of anger is usually a direct reaction to the questions 'How could he/she do this to me? to our kids?'. The problem is that although such reactions are understandable, the very idea of being angry at the deceased adds new layers of guilt to the internal conflicts already present. In addition, there is no way to discuss these feelings with the person who originated them in the first place, so closure is never achieved. In the end, the person feels confused, helpless and unable to find a healthy outlet for such an emotional turmoil. 

Anger is often followed by a sense of rejection and abandonment by those who were closer to the deceased. It is as if with their death they had sent a message like "you don't matter" or "you weren't enough." For families, this perceived statement to the world hits hard and aggravates their pain.

Sadness

When it comes to grief, this is perhaps the most commonly felt emotion, so why mention it at all? Because in suicide, it may take longer for it to show up. Amidst the psychological turbulence caused by death, the bereaved might find it hard to cry at first because they are struggling to come to terms with what happened. Apart from having to adapt to a new life, they are tortured by the fac fact that it was suicide, which implies a choice to die, and by the roller coaster created by the 'whys' and 'what ifs.' When immersed in this deep pool of doubts and confusion, sadness may crawl in camouflaged as fatigue, excessive sleep, and other emotional or physical symptoms. This is particularly true when anger is present because sadness is often concealed by it. One thing is certain: sooner or later, it will make its appearance.

Is it hereditary?

When a family member dies by suicide, one of the thoughts that come up is whether or not it is hereditary. This is also one of the popular myths around this issue. Usually, the family dynamics change in the sense that there is an increased awareness of each other's emotions and psychological states. Individuals are equally more attuned to their own reactions to stress because they want to avoid taking the same route. Such an attitude can help bring families together by strengthening their bonds and by opening up a dialogue so that they can process the loss.

The other side of the coin can have negative consequences, though. The bereaved may become overwhelmed with the fear of genetics, particularly when there is a history of mental illness in the family. A daughter who shares a diagnosis of depression with her father, for example, may believe that the fact that he killed himself means that she will do the same. Research does not validate this belief. Although family members have a higher risk of suicide, this does not mean that it will happen, just as having a history of mental illness doesn't necessarily lead to everyone developing the disease. Additionally, being aware of such predisposition can improve the quality of relationships by bringing family members closer.

 

Another aspect that should never be overlooked is the ripple effect of suicide. If you visualize what happens when someone throws a stone into a river, the waves created by it get thinner according to its distance. This metaphor applies to self-inflicted death. The closer you are to the person who died, the bigger the impact. Such a phenomenon is called contagion, which is related not only to proximity but also to psychological and emotional vulnerability. Those who are going through a life crisis or struggle with mental illness, for instance, are more susceptible to being negatively impacted by suicide exposure. 

How to Help

Knowing what to do when someone you know lost a loved one to suicide can be challenging, so here are some tips on how to show compassion, be present, and avoid mistakes.

  • Don't assume - Most people make this mistake. With the best of intentions, they either keep a distance, hoping that it will help mourners "sort things out," or force their constant presence, believing that "that's what friends do." Each person has a unique way of grieving, so this should be taken into consideration. The best approach is to ASK what they need. Here is an example of what can be said: 

 

"I don't want to assume that I know what you need right now, but I would like to help. If you need me to be present, I'll be here, but if you need space, I'll respect that."

  • Offer practical things - As is the case with other types of deaths, families become overwhelmed by everyday chores. This can be alleviated by simple gestures such as offering to bring meals, help with funeral arrangements, pick up or take the children to school for a few days, run errands such as grocery shopping, watch the kids, and make phone calls.

 

  • Stay close - For family members, isolation is one of the most frequent consequences of suicide. Again, don't assume that they want to be left alone. Stay in contact, offer support, and make them feel cared for, even if you don't know what to say.

  • Expect them to be different - Death pushes people to the limit, which may look like the person is not the same, so expect extreme reactions and mood swings.

  • Avoid reassurances and clichés - Regardless of your intentions, avoid saying "you will be ok" and "everything will be fine." The truth is, they won't, not and for a long time if at all. It is better to say, "When things get tough, I'm here." "They are in a better place" should also be avoided. Rule of thumb is: if you can't guarantee it, don't say it.

  • Talk about the deceased - This is one of the most difficult things to do, because we tend to believe that it will increase the mourner's pain. In suicide loss, it can be the opposite. You may compound the pain, because the most common reaction to suicide is silence, which exacerbates the sense of shame and isolation already present. Reminiscing can be quite healing for the bereaved - just be sure not to focus on the circumstances of their death. A good tip is: remember their life, not their death.

  • Talk about their grief - Don't be afraid to ask how they are doing. Chances are they are willing to talk but have no one who can truly listen. Some ways to start a conversation are:

    • "How are you doing today? It must be hard to talk about your loss. If you want to, I would be honored to listen."

    • "I don't mean to intrude, but I want you to know that I am here to listen if you feel like talking about your loss."

Topic suggestions (in case you don't know what to ask)

- What is getting better/worse with time?

Main challenges (what is the hardest thing to deal with?)

- What's most helpful?

- How are friends/family dealing with the suicide? (use the word)

- Are they feeling isolated?

- How they are coping/taking care of themselves

  • Accept their pace - One of the attitudes that contribute to isolating the bereaved is the belief that no one will understand that they are "still" hurting, so phrases like "you should get over it" and "it's been XX months" may imply that there is something wrong with the way they are experiencing their loss. There is no such thing as the right or wrong way to grieve; everyone has their own pace.

For those who are left behind

  • Reach out to friends who can listen - Not everyone can deal with the pain of others, even when they love them. Having friends and family who are able to listen without judgment can be immensely helpful because of the fear of being blamed for the death. Grief is a time for healing, so be selective about whom you invite into your life. 

  • Avoid making major decisions - You may feel that in order to 'get on with life,' you need to make drastic changes, such as moving, quitting your job, or breaking up relationships. There will be time for all of that. The pain caused by your loss may be clouding your mind, so try to refrain from big decisions. 

  • Expect distance from friends and family - This may sound harsh, but the truth is, most people don't know what to say when faced with suicide. In addition, they may be going through their own pain, so being aware that this will most likely happen may help you to understand their distance and silence. With time, things will readjust. If you miss a person, in particular, there is nothing wrong with reaching out yourself if you feel comfortable doing so. If you are afraid of their questions, keep in mind that you are the one who can and should set the limits on what to talk about and how far to go.

  • Avoid hiding that it was suicide - As hard as it may be, hiding the suicide will have two negative consequences: to strengthen the stigma and to keep people at a distance. Everyone knows it was suicide. The discomfort of not being able to mention the word will make conversations more difficult. By talking openly about it, you will be opening the dialogue with those who are close to you.

  • Spirituality/Religion - If you are a person who has spiritual or religious beliefs, engage in them. This path can be helpful to understanding your own path and to finding meaning. Just be mindful that most religions condemn suicide, so tread carefully when talking to members of your community. You may need more time to participate in collective rituals. 

  • Search for professional help - Talking about your loss is hard for many reasons: you may feel no one will understand, that maybe they think it's your fault, or that you will be a burden, particularly after some time. This is when a psychotherapist can be a good option for you. They are trained to listen with empathy, and compassion, in a non-judgmental way. Counselors can help ameliorate physical and psychological symptoms without the discomfort that comes with tackling some aspects of the loss, including relationship problems with the deceased. Don't be ashamed of seeking help. Grief is tough in any circumstance. No one should go through it alone.

 

  • Read about similar experiences - Feeling isolated is common in suicide loss, so reading about other people's personal struggles can bridge this gap. For books on grief, see my Resources page.

  • Join a support group - Research shows that being able to talk to people who have had a similar experience can be extremely helpful to those who are left behind. For tips on how to find a support group in your area, check my Resources page. 

  • Be kind to yourself - Many of us have heard about the popularized phases of grief, which can add a new layer of expectations regarding the bereavement process. There is no wrong and right way to do it, so try to respect your pace. If you're feeling overwhelmed, do simple things, like going out for a walk (nature is healing), listening to soothing music, engaging in hobbies that bring you pleasure, journaling, eating healthy, and exercising.

How to tell kids

As hard as it may be, don't hide the truth from children. They will find out sooner or later, and this can have future repercussions on their capacity to trust and relate to others. Here are some general tips:

 

  • To facilitate understanding, use age-appropriate language.

  • Reassure them that it was not their fault. Children have a tendency for self-blame and they will create their own version of what happened if the truth is withheld. Try to identify if the child expresses any signs of guilt about the death. 

  • Listen attentively and answer their questions. There is no need for details on how the person died (specific method). Let them know you will be there for further questions. It is okay to say "I don't know."

  • How to explain? One suggestion is to say that self-inflicted death is not a natural fact of life and that the person who did it was not well, which caused them to carry out the suicide. Point out that in cases of mental illness, treatment is the best course of action. Each case has its specificities, and those circumstances should be brought into the conversation. 

  • Talk about the changes that will occur due to the loss (financial, daily tasks, etc.). This will help them anticipate and adapt to them. It will also open up dialogue.

  • Allow them to participate in some decisions regarding the aftermath. For example: ask them to help decide which pictures to use, or what music to play at the wake.

  • Maintain their routine.

For more information, download the American Foundation for Suicide Prevention's guide: Talking to Children About Suicide.

Sources cited: 

1. World Health Organization: CLICK HERE

2. The study conducted with college students by the Brigham and Women's Hospital: CLICK HERE

3. Numbers in the US, Center for Disease Control, CDC: CLICK HERE

4. The study correlating screen time, depression and suicide outcomes: CLICK HERE

5. The Royal Society for Public Health's research (UK): CLICK HERE