The term suicide survivors refer to the family members and close acquaintances of someone who died from suicide. In some ways, coping with the loss of someone close and dear to suicide is experientially identical to coping with death due to illness or accidents. In many ways, however, it is different, due to the drastic and unexpected nature of death which in turn evoke a variety of excruciating emotions. This may include, but are not limited to:
- Shock and numbness from the suddenness of the loss.
- Confusion, disbelief and a desperate search for understanding
- A mixture of anger and of being betrayed or let down by the deceased
- Guilt and shame related to the thought that they did not try hard enough to give support to the deceased through their personal struggles, or that they were not vigilant enough in spotting the warning signs of suicidal ideation.
- Extreme and prolonged feelings of sadness and helplessness
- Uncertainty on how to share their grieving process with others due to the social stigma and misunderstanding surrounding suicide
- The inability to reach out adequately for support further exacerbates feelings of loneliness and abandonment, which in turn significantly increases the risk of depression
Survivors of suicide represent the largest mental health casualties related to suicide, according to Edwin Shneidman, the pioneer in the field of suicidology. It is therefore imperative that both suicide survivors and their close family and friends learn how to cope effectively and appropriately with the unique grieving process of losing someone to suicide.
Below are a list of useful points to keep in mind when reaching out to help and support a suicide survivor:
- Learn to accept the intensity of the emotions and grief that a suicide survivor will go through, particularly during the initial phases of grieving. Unconditional acceptance and support will help them to reconcile themselves to this intensity that may well be beyond the limits experienced in other types of deaths. Be patient, compassionate and understanding.
- Be physically present as an active listener. The willingness to listen non-judgmentally provides a safe space for the expression and acknowledgment of frightening feelings and thoughts, particularly those related to the taboo aspects of suicide. There needs to be patience with the suicide survivor who may need to relate the same story about the death repeatedly; this can be an important component of the grief resolution process.
- Encourage expression of feelings wherever possible. Survivors may perceive (sometimes rightly) that others are either directly or subtly blaming them for the suicide. This often results in denial and suppression of their most difficult feelings, which only exacerbates and complicates the grieving process. However, survivors should be allowed to talk at their own pace; don’t push them and respect that they may also need periods of silence and self-rumination in between the periods of sharing.
- Avoid simplistic explanations and clichés. Trite comments often intended to diminish the loss by providing simple solutions to difficult realities often hurt and may make the journey towards the resolution of grief more difficult. What is called for is empathetic listening, without necessarily offering any kind solution or answer.
- Be certain to avoid passing judgment or providing simplistic explanations of the suicide. Don’t make the mistake of saying the person who committed suicide was “out of his or her mind.” Informing a survivor that someone they loved was “crazy or insane” typically only complicates the situation. Suicide survivors need help in coming to their own search for understanding of what has happened. In the end, their personal search for meaning and understanding of the death is what is really important.
- Allow the grieving process to proceed in its own natural way and time. While there are several standard models for the grieving process, it is useful to bear in mind that everyone is different and will process their grief in a unique way. It is important to be patient and not try to manipulate an early resolution of the grief.
- Be aware of important occasions related to the deceased, such as anniversaries and birthday. Suicide survivors may go through a particular difficult path during this time as these reminders potentially emphasize the absence of the person who has died.
- Be honest and open with children about suicide. Secrecy about the suicide in the hopes of protecting them may cause further complications. Explain the situation and answer children’s questions honestly and with age-appropriate responses. Children are especially vulnerable to feelings of guilt and abandonment. It is important for them to know that the death was not their fault and that someone is there to take care of them.
- Encourage and help suicide survivors connect with others who have or are going through a similar experience. Research has shown that support groups are one of the best ways to help as they provide an ideal venue in which it is easier to share openly without the fear of being embarrassed, misunderstood or judged. The mutual support and understanding offered by such groups can greatly facilitate the grieving process.
- Respect and allow thinking and feelings related to faith and spirituality. Sometimes, this may take the form of anger at God, in which case it is important to allow the suicide survivor to fully express and experience it. Survivors may also need to explore how their religious beliefs affect their grieving process, particularly if their religion teaches that people who die from suicide are doomed to hell. The important task here is not to engage in theological discussions, but to be present and listen non-judgmentally.
- Work together with other care givers to support each other. Supporting a suicide survivor is much easier when it is done in cooperation with other care givers, so that they can provide mutual support and guidance to each other during the rough patches in the journey.
This article was written in conjunction with International Survivors of Suicide Day (November 19th), by Victor Tan, Honorary Secretary of The Befrienders KL. Contact Befrienders KL if you need someone to talk to.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]