In the Shadow
of Suicide - Surviving Stigma and Shame
Social Work Today
By Kate Jackson
Vol. 4 No. 4 p. 36
Twelve women sit stiffly on folding chairs arranged
in a circle. Uneasy and apprehensive, they tug at the boxes of tissues
on the floor at their feet. A few talk nervously, while the rest stare
at the walls, windows, and ceiling. When all the participants have
arrived, the leader of this support group for recently widowed women
asks each person in the circle to introduce herself and tell a little
about how she lost her spouse. She invites the others to comment and
share their perspectives.
The first woman chokes back tears to explain that
her husband died suddenly of a heart attack on the tennis court. The
second says her husband was killed by a careless motorist. The third
explains that her spouse had suffered with cancer for several years,
and the fourth breaks down as she tells the group that her husband,
who’d been lost to her for some years as a result of Alzheimer’s
disease, suffered a fatal stroke. The group members listen attentively
and communicate their interest, understanding, and empathy through
eye contact, body language, and inquisitiveness. They ask for more
information and knowingly acknowledge the anger, disbelief, and shock
they see mirrored in the other faces.
One woman becomes increasingly agitated as her turn
approaches. She eyes the door, fidgets in her seat, and bites at her
nails. She manages to stammer her name—Marjorie—and then
freezes. The leader coaxes her gently to tell the group why she’s
there. She mumbles something and begins to cry. A woman sitting next
to her strokes her back and takes her hand to try to comfort her.
Pressured by the leader, Marjorie, barely audible, says her husband
killed himself six weeks ago. The others in the group look away. They
can’t claim to know her feelings and are unsure what to say.
The group leader merely expresses her sympathy and welcomes her to
the group. At the next meeting, Marjorie is absent.
A Different Kind of Grief
According to John D. Weaver, LCSW, author and crisis intervention
specialist, the circumstances of a suicide may determine the degree
to which grieving is complicated, but all survivors will struggle
not only with the shock of their loss but also with the quicksand
of emotions that follow. “There’s going to be extra trauma
if someone finds the person who has committed suicide or witnessed
them doing the suicide, and there’s a greater potential for
increased guilt or shame with a suicide over other types of death,”
he says. Furthermore, some individuals grieving a loss by suicide
may be so overwhelmed by their emotions that they are themselves at
risk for suicide.
Everyone who grieves the loss of a loved one suffers
a range of emotions—from anger to guilt. Family ties and social
support are often enough to help individuals cope with such losses
over time. Those who grieve for someone who commits suicide may be
overwhelmed by the same emotions, but guilt plays a more prominent
role and is often accompanied by shame. Suicide and these potentially
devastating emotions that arise in its wake are generally difficult
to talk about for survivors. For family, friends, and caregivers of
the bereaved, it’s often excruciating to ask about the suicide
or listen to the story.
Susan Powers, PhD, an experiential psychotherapist
trained in gestalt therapy and psychodrama, knows from personal experience
the ways in which grieving a suicide is different—and perhaps
far more lonely an experience—than grieving other kinds of losses.
Two and a half years ago, her husband died of kidney cancer, only
six months after he had been diagnosed. “He died with hospice
in a very healthy way—very complete, emotionally connected,
and conscious,” says Powers. Less than three months later, she
received word that her daughter, who had been addicted to heroin and
homeless in California, died in the street of an overdose.
“It was so clear to me the difference between
a healthy death and an unhealthy death,” says Powers. After
the latter, she says, there’s no chance to say good-bye and,
thus, no sense of completion. “I was shattered,” she recalls,
“but what later became so interesting to me was the difference
of grieving someone who dies in a more natural way and the special
difficulties of grieving someone who dies from suicide or addiction.”
Guilt And Shame
Guilt and shame, which tend to go hand in hand for many survivors
of suicide, may spring from a variety of issues. After a suicide,
a loved one might experience guilt over the possibility that they
contributed to the desire to die or that they could perhaps have prevented
the suicide. These feelings of responsibility may be heightened if
the suicide victim battled addictions. “Any time people are
using drugs or alcohol, it disinhibits them, so it tends to make them
more prone to act impulsively and to act in a way that might complete
the suicide more so than a suicide attempt that might be attention-getting,”
says Weaver.
When people die of addiction, says Powers, guilt and
shame are magnified by the awareness that the person was complicit
in their own death through their own self-destructive behavior. Very
often, says Powers, “the person has been kind of disappearing
from your life in many ways and there have been many difficult decisions
that had to be made about how to get help, how much to intervene,
how to know if it’s just depression or addiction, or both.”
Usually, she says, it’s a very complicated relationship. “In
my experience, after a suicide or an addictive death, all the people
close to the person who died feel guilty in some way,” says
Powers.
Guilt is common among all mourners, but in the case
of suicide, she insists, the feelings are often extreme. “There’s
a typical shock and numbness that happens, but after that, there’s
a lot of shame and blame that goes around the family and friends,
and there’s a great deal of alienation afterward as people blame
each other. Everything is so much more complicated, and the personalizing
of the death—in shame and blame—is so much greater.”
Shame, says Powers, “is like a dark pit, and there’s no
way out of it.” Guilty people, she observes, think they made
a mistake. Shamed people, however, think they are a mistake. There
may be so many feelings of worthlessness that they think they’re
undeserving of help.
Social workers can best help survivors put feelings
of guilt in a more rational perspective by listening and helping them
talk and work through the emotions, suggests Weaver. Clients, he says,
may need help accepting that while things may not have been as good
as they could have been in a relationship, they can’t change
that now. It’s helpful for them to acknowledge that they’re
not likely to be entirely responsible, if responsible at all, for
the deficiencies in the relationship. “Certainly, some of it
was a result of the deceased’s issues,” says Weaver, “and
either one of them could have made for a better relationship.”
Survivors who are plagued by guilt associated with
failing to anticipate or prevent the suicide can be comforted through
reassurance. Social workers, suggests Weaver, “can help clients
refocus a little on the fact that we just don’t have good predictors
of who will commit suicide. Nothing is a sure thing. People are extremely
resilient in some aspects of life and other people are not.”
Therefore, he indicates, it’s nearly impossible to predict in
every case who will or will not take their own life. “Some people
are hard-core suicidal, and no matter how good a support system you
try to build around them, if they’re bent on taking their life,
they have that option. Even if they’re in a locked psychiatric
unit with 24-hour supervision, people can find a way.”
Lack of Support
Accompanying shame, another pitfall to the resolution of grief, says
Powers, is isolation. “There’s a tendency in grieving
to want to be alone. It’s a natural desire to go and be alone
to lick your wounds,” she observes. “People grieve in
different ways. Some need more alone time than others.” Still,
she says, too much isolation only deepens and complicates grieving.
“You don’t want to be alone and suffering. There’s
a phrase in recovery that pain is necessary, but suffering is optional.”
Suffering, she says, is the self-flagellation and self-hatred, and
pain is just pain. “But pain shared is reduced, and to be able
to talk about it is just what’s needed.” But paradoxically,
just when you don’t want to talk about it is when you most need
to talk about it, suggests Powers.
“Many people just withdraw as they so often
do when dealing with mental illness in a family,” explains Weaver.
“Because of the stigma associated with suicide,” he adds,
“people just don’t tend to want to talk about it, so some
of the natural caring and support that might go on were it a different
kind of death is probably less likely to occur.” Even the most
well-meaning people, he explains, may not want to further upset the
grieving person by opening a door to conversation. In a sense, it’s
another loss for the survivor because, says Weaver, “it can
be helpful to talk it out and shift some of the memory focus to good
times they might have had with the person they grieve for, not visions
of them in death or in moving toward death if the person had been
leading a reckless lifestyle.”
“People don’t know what to say or do,”
agrees Powers, so they often say hurtful, unhelpful, or foolish things.
Although it challenges their boundaries, she insists, grievers must
be encouraged to reply to such statements by saying, “That’s
not very helpful to me right now” or “I can’t hear
that right now.” “There’s not much you can say,”
she acknowledges, “but what the griever really needs is just
to be heard and listened to.” Silence, maintains Powers, is
what kills people. She refers, for example, to a colleague, another
therapist, who killed herself just days after losing a child to a
suicide by overdose. Powers understands the shame. “I worked
as a therapist, too, and there was that feeling that I couldn’t
help my own daughter. If she could die like that, how could I help
people? So there was professional shame on top of codependent shame
on top of family shame. But it did kill my friend, and I have the
feeling that she really wasn’t able to face it and talk about
what happened.” Sadly, says Powers, that’s not an uncommon
reaction.
Breaking The Silence
The real solution to shame and blame, she says, is telling the story.
“There’s so much secrecy about suicide or an addictive
death,” says Powers. “So many suicides, for example, are
related to a chemical addiction of some kind, and very often that’s
not stated.” It’s talked about as if there were no connection
to addiction because for some people, that’s seen as more shameful.
Social workers who wish to help their clients cope
in the aftermath of suicide can encourage them to share their experiences
and feelings. It’s highly therapeutic for the bereaved to tell
their story again and again to a compassionate listener. Following
a suicide, however, the mourners may need to be drawn out. “If
you can tap into their story and ask what happened, it often opens
the floodgates. If you can push through their phobias about such questions—people
welcome an empathetic listener,” says Powers. She advises grievers
to be ruthless—to say, “This happened to me, and you’re
going to be hearing about it.” They need to be equally ruthless,
she stresses, in silencing people who are saying things that are hurtful.
Mending Relationships
One of the more difficult aspects of grieving after suicide is the
lack of closure or inability to right relationships that have gone
wrong. Social workers or other therapists can help survivors simulate
closure and add dimension to the memory of the relationship. Caregivers
can “help them get things said that they might have wanted to
say to the individuals but didn’t get a chance because of the
suicide,” says Weaver. This, he says, “might run the gamut
of emotions—from anger at them for doing it to sadness at the
loss.”
Powers brought her personal experience to bear upon
her professional practice and began giving an experiential workshop
called “Grieving the Unheroic Death” for those who lose
loved ones to suicide or addiction. Because there’s so often
a film of disgrace overlaying a suicide, Powers seeks in this workshop
to both honor the life of those who have taken their own lives and
stress that they deserve the same respect as those who have died from
natural causes. “Very often, people need to experience a ritual
that is loving and not shameful,” she notes, so participants
are encouraged to bring a photograph and create an altar to their
lost loved one. Powers encourages role playing—having someone
stand in for the lost loved one and allowing the griever to talk to
them, even get angry with them. Similarly, she advises people with
these kinds of losses to write letters to the loved one to express
feelings they were not able to express in life. “Letter writing
is helpful,” she says, because it allows people to complete
the relationship as much as possible. In another technique, she takes
the correspondence a step further and asks the person to respond to
the letter as the loved one might have. She reminds her clients that
they knew the person very well and they’re capable of knowing
how they might have responded. “I help them set up a writing
dialogue, and it’s amazing what comes out of it,” she
says. A surprising result of this is often an expression of wellwishing.
“There’s often been so much anger in the family or in
the relationships, especially when there’s addiction or severe
depression, but the antagonism tends to fade away with death so that
people are often able to get to a more loving place with each other.”
Contagion
Social workers who counsel individuals grieving loss by suicide must
always be alert to the concept of contagion and be vigilant about
suicide prevention. According to experts, suicide tends to beget suicide.
Sometimes, observes Weaver, it can simply take away someone else’s
will to live. This is especially likely to occur if the survivor’s
mission has been to take care of a depressed family member and that
person is suddenly gone. The person who’s been the caretaker
may become suicidal.
A family history of suicide increases one’s
risk of suicide, and highly publicized suicides can cause copycat
behavior. According to the American Foundation for Suicide Prevention,
an article in the newspaper about suicide often leads others to consider
or commit suicide. Explains Weaver, “Suicide sometimes sets
a sort of family standard. If you have a family in which many people
have committed suicide, it becomes a learned violent behavior as a
means of coping with stress.” Contagion, he suggests, may occur
not only to family and close friends of suicides but even to complete
strangers. “There’s contagion sometimes when famous people—either
as a character in a movie or in real life—kill themselves.”
It’s a phenomenon that occurs in schools as well, he explains,
“where sometimes there’ll be a run of suicides.”
Contagion is especially likely to happen when the person who commits
suicide is very popular. “Other kids who are on the margins
may think that if a popular kid who had everything going for him couldn’t
hack life, why should they?” How the family or school system
responds in the aftermath of a suicide, he adds, may increase the
risk of contagion. Sometimes overmemorializing, he explains, “can
make death look more attractive than life for people who don’t
feel connected to life.”
Social workers, then, must be alert to the potential
for suicide among those grieving a suicide. These clients, says Weaver,
must be carefully monitored. Caregivers should encourage them to keep
in close contact with other people and help them build a support system
around them that might include family, friends, coworkers, spiritual
leaders, or others they might turn to. “If a team of folks are
watching, the person might avoid contagion,” he says.
To combat contagion and prevent suicides, social workers,
says Weaver, must not be afraid to raise the subject. It’s crucial
to reject the myths that lead people to believe that if you talk about
something, you’ll cause it to happen. “That’s not
the case,” reminds Weaver. “Generally, people who are
suicidal have been thinking about it for a long time. It’s often
a five-year process from the time suicidal people first thought the
world would be better off without them to the point at which they
take their own lives, and there may have been attempts along the way
and efforts at improving the planning.”
Therefore, he suggests, therapists must encourage
their clients to reveal suicidal feelings and take seriously any suspicions
that a client may be so depressed that he or she might harm themselves
or contemplate suicide. “Helping professionals especially must
be comfortable using the word “suicide” in a sentence
and not be afraid to ask if they’re getting a vibe that someone
might be thinking of killing themselves and ask in plain language,
‘Are you thinking about that, and if you’re thinking about
that, how would you do it, when would you do it?’” It’s
crucial, Weaver insists, to find out whether or not the person has
a plan and whether or not he or she has gotten that far, to take steps
to work with crisis intervention to get an emergency commitment if
necessary so everyone can help prevent an attempt.
It’s also important for social workers to encourage
people in the survivor’s support system to take the risk and
call the hotlines if they suspect that someone is suicidal. Help them
understand that it’s better to err on the side of caution. “It’s
better to have people mad at you because you tried to hospitalize
them than have to live with the fact that you think you could have
prevented something but didn’t try,” says Weaver.
In addition to close monitoring and contact, social
workers, says Weaver, should employ a strategy of diffusing and debriefing.
It may also be helpful to encourage clients to attend survivor groups,
helping them focus on the positive aspects of life so the negative
image of death doesn’t linger and overwhelm them. This is especially
important for clients who witnessed the death or found or witnessed
the body after the suicide. When a student commits suicide, says Weaver,
the school can help by reaching out to the child or teenager’s
closest friends so they can help avoid contagion. “School social
workers may also want to help the students think about a memorial
of their own by asking how they’re going to look back on the
person’s life a year down the road and help them get ready for
the anniversary reaction they may have year after year on the anniversary
of the death.”
In the End
Suicide is an ending, but it never permits real closure. Concludes
Weaver, “It’s generally something that families years
and years later are still reflecting upon like other life traumas.
It’s like people who survive a hurricane and never forget it.
It changes their lives forever. It just tends to be a permanent memory
that is troubling for years and years to come.”
— Kate Jackson is a staff writer for Social
Work Today.
Resources
American Association for Suicidology
www.suicidology.org
Centers for Disease Control and Prevention
www.cdc.gov
National Institute of Mental Health
www.nimh.nih.gov
Substance Abuse and Mental Health Services Administration
www.samhsa.gov
Office of the Surgeon General National Strategy for
Suicide Prevention
www.mentalhealth.org/suicideprevention
Suicide Prevention Advocacy Network USA, Inc.
www.spanusa.org
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